Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2012010073 | MO |
N | 111NS0005X | Chiropractic Sports Physician | 8446 | AZ |
NPI | 1073867685 |
---|---|
Provider Name | Dr. Patricia Ann Pellegrino |
First Address | House Springs, MO 63051-2120 |
Second Address | House Spring, MO 63051-2120 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2012 |
Last Update Date | 16/03/2015 |