Healthcare Provider Details

I. General information

NPI: 1821931916
Provider Name (Legal Business Name): BEAU FORTIER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 DEL PRADO BLVD S
CAPE CORAL FL
33904-7169
US

IV. Provider business mailing address

4727 MIRAGE BAY CIR UNIT 409
FORT MYERS FL
33966-6626
US

V. Phone/Fax

Practice location:
  • Phone: 239-470-1065
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH15201
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: