Healthcare Provider Details

I. General information

NPI: 1639157407
Provider Name (Legal Business Name): JOSEPH DOMENIC FORTUNATO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6321 N KEYSTONE AVE STE A
INDIANAPOLIS IN
46220-2156
US

IV. Provider business mailing address

6321 N KEYSTONE AVE STE A
INDIANAPOLIS IN
46220-2156
US

V. Phone/Fax

Practice location:
  • Phone: 317-257-2225
  • Fax: 317-257-0646
Mailing address:
  • Phone: 317-257-2225
  • Fax: 317-257-0646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001070A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: