Healthcare Provider Details

I. General information

NPI: 1699621060
Provider Name (Legal Business Name): GULF COAST MUA PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 SE 18TH AVE
CAPE CORAL FL
33990-4707
US

IV. Provider business mailing address

2125 SE 18TH AVE
CAPE CORAL FL
33990-4707
US

V. Phone/Fax

Practice location:
  • Phone: 913-948-1328
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH R CONIGLIARO
Title or Position: OWNER/DC
Credential: DC, FACMUAP
Phone: 913-948-1328