Healthcare Provider Details

I. General information

NPI: 1932391125
Provider Name (Legal Business Name): GLENDALE CHIROPRACTIC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 09/02/2025
Certification Date: 08/06/2025
Deactivation Date: 04/15/2008
Reactivation Date: 05/20/2008

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
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 TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number08001070
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001070
License Number StateIN

VIII. Authorized Official

Name: DR. JOSEPH D FORTUNATO
Title or Position: OWNER
Credential: DC
Phone: 317-257-2225