MEDICARE: DR. RONALD J. PELLICANI D.C.

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	111N00000X	Chiropractor	1610	MA
2	111N00000X	Chiropractor	3616	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	994529	OTHER	MA	NETWORK HEALTH PLAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	Y36167	OTHER	MA	BC/BS OF MA
5	181432	OTHER	MA	AETNA
6	0014298	OTHER	MA	NEIGHBORHOOD HEALTH PLAN

General Provider Information

NPI Number	:	1558462887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD J. PELLICANI D.C.

Provider Business Mailing Address
First Line	:	4016 RIVER OAKS DR # 149
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-6673
Country	:	US
Telephone Number	:	843-236-2200
Fax Number	:

Provider Business Practice Location Address
First Line	:	568 GEORGE BISHOP PKWY
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-7339
Country	:	US
Telephone Number	:	843-236-2200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	02/26/2021

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