Active NPI
Marc Joseph Fondino, DC
- Chiropractor
- Davidson, NC
National Provider Identifier
1588779573
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 3004
- Practice address
- 428 South Main Street
Suite D
Davidson, NC 28036 - Phone
- (704) 655-0700
- Fax
- (704) 655-0701
- NPI assigned
- Aug 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 3004 | NC | Primary |
Addresses
Primary practice location
428 South Main Street
Suite D
Davidson, NC 28036
Mailing address
428 South Main Street
Suite D
Davidson, NC 28036
Phone (704) 655-0700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 89085HV | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- New York Chiropractic College, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
PO Box
Suite 2484
Davidson, NC 28036
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3004 | NC | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Davidson Health Assoc PA | Chiropractor | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156032000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1588779573",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "428 SOUTH MAIN STREET",
"address_2": "SUITE D",
"city": "DAVIDSON",
"state": "NC",
"postal_code": "28036",
"telephone_number": "704-655-0700",
"fax_number": "704-655-0701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "428 SOUTH MAIN STREET",
"address_2": "SUITE D",
"city": "DAVIDSON",
"state": "NC",
"postal_code": "28036",
"telephone_number": "704-655-0700",
"fax_number": "704-655-0701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONDINO",
"first_name": "MARC",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "NC",
"license": "3004",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "89085HV",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Davidson, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.