Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 01 04718 | KS |
NPI | 1003896309 |
---|---|
Provider Name | Joseph R Conigliaro |
First Address | Overland Park, KS 66210 |
Second Address | Overland Park, KS 66210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 11/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
29483037 | BLUE CROSS BLUE SHIELD (01) | |
627731 | UNITED HEALTH CARE ACN (01) | |
7682235 | AETNA (01) | |
U86946 | (02) |