Healthcare Provider Details

I. General information

NPI: 1194645853
Provider Name (Legal Business Name): CENTRAL CITY ORTHOPEDIC AND SPINE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W BUCKEYE RD STE 304
PHOENIX AZ
85003-2693
US

IV. Provider business mailing address

21722 FALL RIVER DR
BOCA RATON FL
33428-4818
US

V. Phone/Fax

Practice location:
  • Phone: 480-257-1971
  • Fax:
Mailing address:
  • Phone: 480-257-1971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SAL J PELLEGRINO
Title or Position: OWNER/MGNT MEMBER
Credential: DC
Phone: 954-658-0064