Provider Demographics
NPI:1073867685
Name:PELLEGRINO, PATRICIA ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ANN
Last Name:PELLEGRINO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4543 DULIN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HOUSE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:63051-2120
Mailing Address - Country:US
Mailing Address - Phone:636-671-5440
Mailing Address - Fax:
Practice Address - Street 1:4543 DULIN CREEK RD.
Practice Address - Street 2:
Practice Address - City:HOUSE SPRING
Practice Address - State:MO
Practice Address - Zip Code:63051-2120
Practice Address - Country:US
Practice Address - Phone:636-671-5540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012010073111N00000X
AZ8446111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician