Provider Demographics
NPI:1336454990
Name:PELLEGRIN, JASON PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:PAUL
Last Name:PELLEGRIN
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 1:714 PHOSPHOR AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-2727
Mailing Address - Country:US
Mailing Address - Phone:504-224-8400
Mailing Address - Fax:504-272-0237
Practice Address - Street 1:714 PHOSPHOR AVE
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-2727
Practice Address - Country:US
Practice Address - Phone:504-224-8400
Practice Address - Fax:504-272-0237
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-08
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1573111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor