Provider Demographics
NPI:1508908849
Name:PELLEGRINO, SAL JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:SAL
Middle Name:JAMES
Last Name:PELLEGRINO
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 1:4021 N ANDREWS AVE
Mailing Address - Street 2:STE. 6
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-5297
Mailing Address - Country:US
Mailing Address - Phone:954-396-3908
Mailing Address - Fax:954-630-3359
Practice Address - Street 1:4021 N ANDREWS AVE
Practice Address - Street 2:STE. 6
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-5297
Practice Address - Country:US
Practice Address - Phone:954-396-3908
Practice Address - Fax:954-630-3359
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005659111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55235OtherBCBS PROVIDER NUMBER