Healthcare Provider Details

I. General information

NPI: 1447546916
Provider Name (Legal Business Name): LANSING CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4136 LEGACY PKWY SUITE 100
LANSING MI
48911-4265
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: 561-367-1333
  • Fax: 561-367-1320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009820
License Number StateMI

VIII. Authorized Official

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