MEDICARE: DANIEL VINCENT FORTUNA D.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	038009315	IL

General Provider Information

NPI Number	:	1538325048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL VINCENT FORTUNA D.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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2008
Last Update Date	:	08/04/2008

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