Healthcare Provider Details

I. General information

NPI: 1275345860
Provider Name (Legal Business Name): HAWTHORNE MEDICAL MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21722 FALL RIVER DR
BOCA RATON FL
33428-4818
US

IV. Provider business mailing address

21722 FALL RIVER DR
BOCA RATON FL
33428-4818
US

V. Phone/Fax

Practice location:
  • Phone: 954-658-0064
  • Fax:
Mailing address:
  • Phone: 954-658-0064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. SAL JAMES PELLEGRINO
Title or Position: OWNER/ CHIROPRACTOR
Credential: DC
Phone: 954-658-0064