MEDICARE: DANIEL V. FORTUNA, D.C., S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0634272	OTHER	IL	BCBS OF ILLINOIS

General Provider Information

NPI Number	:	1538281589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL V. FORTUNA, D.C., S.C.

Provider Business Mailing Address
First Line	:	2947 OAK PARK AVE
Second Line	:
City	:	BERWYN
State	:	IL
Zip	:	60402-3048
Country	:	US
Telephone Number	:	708-749-0606
Fax Number	:	708-749-7793

Provider Business Practice Location Address
First Line	:	2947 OAK PARK AVE
Second Line	:
City	:	BERWYN
State	:	IL
Zip	:	60402-3048
Country	:	US
Telephone Number	:	708-749-0606
Fax Number	:	708-749-7793

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANIEL VINCENT FORTUNA
Credential	:	D.C.
Telephone Number	:	708-749-0606

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	08/22/2020

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