Provider Demographics
NPI:1376719146
Name:PELOSI, DAVID ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANTHONY
Last Name:PELOSI
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 1:511 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-1816
Mailing Address - Country:US
Mailing Address - Phone:401-654-8222
Mailing Address - Fax:401-453-0914
Practice Address - Street 1:511 BROADWAY
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-1816
Practice Address - Country:US
Practice Address - Phone:401-654-8222
Practice Address - Fax:401-453-0914
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00444111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor