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General NPI Number Information
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NPI Number | 1669129136
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Entity Type | Individual
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Provider Name | KATIE ROSE FORTMAN DC
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Gender | Female
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Dates
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Enumeration Date | 03/04/2022
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Last Update Date | 02/22/2024
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Provider Practice Location Address
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Address Line | 600 W CHICAGO AVE STE 1000
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City | CHICAGO
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State | IL
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Zip | 60654-2801
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Country | US
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Telephone | 312-625-0845
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 W 14TH PL UNIT 109
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City | CHICAGO
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State | IL
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Zip | 60608-2796
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Country | US
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Telephone | 708-945-8437
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038013753
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License Number State | IL
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