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General NPI Number Information
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NPI Number | 1457792731
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Entity Type | Organization
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Legal Business Name | RICHARD PELLEGRINO DC INC
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1133 S MILITARY TRL
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City | DEERFIELD BEACH
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State | FL
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Zip | 33442-7645
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Country | US
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Telephone | 954-571-9555
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Fax | 954-571-9692
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Provider Business Mailing Address
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Address Line | 1133 S MILITARY TRL
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City | DEERFIELD BEACH
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State | FL
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Zip | 33442-7645
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Country | US
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Telephone | 954-571-9555
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Fax | 954-571-9692
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD PELLEGRINO
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Credential | D.C.
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Telephone | 954-600-4655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | CH9109
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License Number State | FL
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