=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154225712
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VINCENT JUE TOLISANO DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2026
-----------------------------------------------------
Last Update Date | 10/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 210 DEL PRADO BLVD S STE 3
-----------------------------------------------------
City | CAPE CORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33990-1763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-574-8000
-----------------------------------------------------
Fax | 239-574-1004
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1106 SE 22ND ST
-----------------------------------------------------
City | CAPE CORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33990-4619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-574-8000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 16150
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------