Individual provider Active NPI

Edward Anthony Pappagallo, DC

  • Chiropractor
  • Daytona Beach, FL
National Provider Identifier
1053445494
Registry record updated Jun 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH 5876 Issued in FL
Practice address
140 S Beach St
Suite 302
Daytona Beach, FL 32114-4472
Phone
(386) 255-3007
Fax
(386) 255-4008
NPI assigned
Mar 16, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH 5876 FL Primary

Addresses

Primary practice location

140 S Beach St
Suite 302
Daytona Beach, FL 32114-4472

Mailing address

140 S Beach St
Suite 302
Daytona Beach, FL 32114-4409
Phone (386) 255-3007

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CH 5876FLMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Palmer College Foundation Chiropractor Past Accepting new patients
Palmer College Foundation Chiropractor PastSince Aug 19, 2004 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371600000000",
    "number": "1053445494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 S BEACH ST",
            "address_2": "SUITE 302",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321144409",
            "telephone_number": "386-255-3007",
            "fax_number": "386-255-4008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 S BEACH ST",
            "address_2": "SUITE 302",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321144472",
            "telephone_number": "386-255-3007",
            "fax_number": "386-255-4008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAPPAGALLO",
        "first_name": "EDWARD",
        "middle_name": "ANTHONY",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-16",
        "last_updated": "2013-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH 5876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Daytona Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.