Patricia Ann Pellegrino, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2012010073 Issued in MO

Practice address

4543 Dulin Creek Rd.
House Spring, MO 63051-2120

Phone

(636) 671-5540

NPI assigned

Nov 5, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1352073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426464000000",
    "number": "1073867685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4543 DULIN CREEK RD",
            "city": "HOUSE SPRINGS",
            "state": "MO",
            "postal_code": "630512120",
            "telephone_number": "636-671-5440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4543 DULIN CREEK RD.",
            "city": "HOUSE SPRING",
            "state": "MO",
            "postal_code": "630512120",
            "telephone_number": "636-671-5540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELLEGRINO",
        "first_name": "PATRICIA",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-11-05",
        "last_updated": "2015-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2012010073",
            "primary": true
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "AZ",
            "license": "8446",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2015; 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.