Healthcare Provider Details

I. General information

NPI: 1891027595
Provider Name (Legal Business Name): CHIRO-MEDICAL OF SOUTH ORLANDO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5533 S ORANGE AVE
ORLANDO FL
32809-3492
US

IV. Provider business mailing address

731 NE 32ND ST
BOCA RATON FL
33431-6918
US

V. Phone/Fax

Practice location:
  • Phone: 561-367-1333
  • Fax: 561-367-1320
Mailing address:
  • Phone: 561-367-1344
  • Fax: 561-367-1320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8212
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH4734
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH5659
License Number StateFL

VIII. Authorized Official

Name: DR. SAL JAMES PELLEGRINO
Title or Position: PRESIDENT/DOCTOR
Credential: D.C.
Phone: 561-367-1333