Provider Demographics
NPI:1336129097
Name:FORTUNA, DORIS J (DC)
Entity Type:Individual
Prefix:DR
First Name:DORIS
Middle Name:J
Last Name:FORTUNA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7626 N OAK TRFY
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64118-1751
Mailing Address - Country:US
Mailing Address - Phone:816-468-5200
Mailing Address - Fax:816-468-5201
Practice Address - Street 1:7626 N OAK TRFY
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118-1751
Practice Address - Country:US
Practice Address - Phone:816-468-5200
Practice Address - Fax:816-468-5201
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004016111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO05886016OtherBLUE CROSS BLUE SHIELD
MOT73819Medicare UPIN
MOS076532Medicare ID - Type Unspecified