Provider Demographics
NPI:1538325048
Name:FORTUNA, DANIEL VINCENT (DC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:VINCENT
Last Name:FORTUNA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2947 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
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009315111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor