MEDICARE: DAVID PELLETIER DC

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	111NR0400X	Rehabilitation Chiropractor	DC-05222	OH
2	111N00000X	Chiropractor	DC-05222	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC05222	OTHER	OH	CHIROPRACTIC

General Provider Information

NPI Number	:	1780398966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID PELLETIER DC

Provider Business Mailing Address
First Line	:	PO BOX 700688
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78270-0688
Country	:	US
Telephone Number	:	800-404-6050
Fax Number	:	210-313-3397

Provider Business Practice Location Address
First Line	:	5845 FAR HILLS AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45429-2209
Country	:	US
Telephone Number	:	800-404-6050
Fax Number	:

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

Provider Enumeration Date	:	01/11/2023
Last Update Date	:	10/16/2025

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Directions to “ DAVID PELLETIER DC” Practice Location

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