MEDICARE: RICHARD PELLEGRINO DC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization	CH9109	FL

General Provider Information

NPI Number	:	1457792731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD PELLEGRINO DC INC

Provider Business Mailing Address
First Line	:	1133 S MILITARY TRL
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-7645
Country	:	US
Telephone Number	:	954-571-9555
Fax Number	:	954-571-9692

Provider Business Practice Location Address
First Line	:	1133 S MILITARY TRL
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-7645
Country	:	US
Telephone Number	:	954-571-9555
Fax Number	:	954-571-9692

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RICHARD PELLEGRINO
Credential	:	D.C.
Telephone Number	:	954-600-4655

Provider Enumeration Date	:	07/15/2013
Last Update Date	:	07/21/2022

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