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General NPI Number Information
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NPI Number | 1275345860
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Entity Type | Organization
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Legal Business Name | HAWTHORNE MEDICAL MANAGEMENT, INC.
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Dates
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Enumeration Date | 01/22/2025
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 21722 FALL RIVER DR
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City | BOCA RATON
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State | FL
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Zip | 33428-4818
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Country | US
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Telephone | 954-658-0064
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Fax |
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Provider Business Mailing Address
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Address Line | 21722 FALL RIVER DR
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City | BOCA RATON
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State | FL
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Zip | 33428-4818
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Country | US
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Telephone | 954-658-0064
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Fax |
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Authorized Official
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Title or Position | OWNER/ CHIROPRACTOR
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Name | DR. SAL JAMES PELLEGRINO
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Credential | DC
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Telephone | 954-658-0064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NP0017X
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Taxonomy Name | Pediatric Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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