Provider Demographics
NPI:1285716381
Name:FORTUNA CHIROPRACTIC CLINIC LLC
Entity type:Organization
Organization Name:FORTUNA CHIROPRACTIC CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:FORTUNA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-468-5200
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004016111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOS070000Medicare ID - Type Unspecified