Provider Demographics
NPI:1538281589
Name:DANIEL V. FORTUNA, D.C., S.C.
Entity Type:Organization
Organization Name:DANIEL V. FORTUNA, D.C., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:FORTUNA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-749-0606
Mailing Address - Street 1:2947 OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3048
Mailing Address - Country:US
Mailing Address - Phone:708-749-0606
Mailing Address - Fax:708-749-7793
Practice Address - Street 1:2947 OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3048
Practice Address - Country:US
Practice Address - Phone:708-749-0606
Practice Address - Fax:708-749-7793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0634272OtherBCBS OF ILLINOIS
ILK07384Medicare ID - Type Unspecified