Healthcare Provider Details

I. General information

NPI: 1831715135
Provider Name (Legal Business Name): FORTUNA CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 S FORTUNA BLVD
FORTUNA CA
95540-3034
US

IV. Provider business mailing address

739 S FORTUNA BLVD
FORTUNA CA
95540-3034
US

V. Phone/Fax

Practice location:
  • Phone: 707-682-6155
  • Fax:
Mailing address:
  • Phone: 707-682-6155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER CAMPAGNA
Title or Position: CEO
Credential: DC
Phone: 678-699-3238