Provider Demographics
NPI:1679854764
Name:TOLISANO, JOSEPH MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:TOLISANO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1456 PERIWINKLE WAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANIBEL
Mailing Address - State:FL
Mailing Address - Zip Code:33957-4512
Mailing Address - Country:US
Mailing Address - Phone:239-472-0900
Mailing Address - Fax:239-472-1968
Practice Address - Street 1:1456 PERIWINKLE WAY
Practice Address - Street 2:SUITE C
Practice Address - City:SANIBEL
Practice Address - State:FL
Practice Address - Zip Code:33957-4512
Practice Address - Country:US
Practice Address - Phone:239-472-0900
Practice Address - Fax:239-472-1968
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10405111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor