MEDICARE: CHIRO-MEDICAL PAIN RELIEF CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH5659	FL

General Provider Information

NPI Number	:	1780915322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIRO-MEDICAL PAIN RELIEF CENTER, INC.

Provider Business Mailing Address
First Line	:	731 NE 32ND ST
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33431-6918
Country	:	US
Telephone Number	:	561-367-1333
Fax Number	:	561-367-1320

Provider Business Practice Location Address
First Line	:	1395 W SUNRISE BLVD
Second Line	:	SUITE 1
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33311-7076
Country	:	US
Telephone Number	:	561-367-1333
Fax Number	:	561-367-1320

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	DR. SAL JAMES PELLEGRINO
Credential	:	D.C.
Telephone Number	:	561-367-1333

Provider Enumeration Date	:	01/21/2010
Last Update Date	:	01/21/2010

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