Provider Demographics
NPI:1629300322
Name:CHIRO-MEDICAL OF KISSIMMEE, INC.
Entity Type:Organization
Organization Name:CHIRO-MEDICAL OF KISSIMMEE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:PELLEGRINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-367-1333
Mailing Address - Street 1:731 NE 32ND ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6918
Mailing Address - Country:US
Mailing Address - Phone:561-367-1344
Mailing Address - Fax:
Practice Address - Street 1:825 E OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5838
Practice Address - Country:US
Practice Address - Phone:561-367-1344
Practice Address - Fax:561-367-1320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5659111N00000X
FLCH8212111N00000X
FLCH4734111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty