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General NPI Number Information
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NPI Number | 1932391125
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Entity Type | Organization
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Legal Business Name | GLENDALE CHIROPRACTIC P.C.
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 6321 N KEYSTONE AVE STE A
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City | INDIANAPOLIS
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State | IN
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Zip | 46220-2156
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Country | US
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Telephone | 317-257-2225
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Fax | 317-257-0646
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Provider Business Mailing Address
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Address Line | 6321 N KEYSTONE AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46220-2156
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Country | US
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Telephone | 317-257-2225
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Fax | 317-257-0646
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSEPH D FORTUNATO
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Credential | DC
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Telephone | 317-257-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 08001070
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 08001070
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License Number State | IN
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