Provider Demographics
NPI:1730314170
Name:PELAYO, JOSE A (DC)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:A
Last Name:PELAYO
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 1:1500 SW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2043
Mailing Address - Country:US
Mailing Address - Phone:305-448-1500
Mailing Address - Fax:305-448-8681
Practice Address - Street 1:1500 SW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2043
Practice Address - Country:US
Practice Address - Phone:305-448-1500
Practice Address - Fax:305-448-8681
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5513111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050492100Medicaid
FL22047Medicare PIN