Provider Demographics
NPI:1053445494
Name:PAPPAGALLO, EDWARD ANTHONY (DC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:ANTHONY
Last Name:PAPPAGALLO
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 1:140 S BEACH ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-4409
Mailing Address - Country:US
Mailing Address - Phone:386-255-3007
Mailing Address - Fax:386-255-4008
Practice Address - Street 1:140 S BEACH ST
Practice Address - Street 2:SUITE 302
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-4472
Practice Address - Country:US
Practice Address - Phone:386-255-3007
Practice Address - Fax:386-255-4008
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 5876111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
22407YMedicare PIN