Provider Demographics
NPI:1548477706
Name:PELLEGRINI, JOHN JOSEPH (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:PELLEGRINI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2212
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95763-2212
Mailing Address - Country:US
Mailing Address - Phone:916-852-0149
Mailing Address - Fax:916-852-8052
Practice Address - Street 1:11327 FOLSOM BLVD # 140
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95742-6224
Practice Address - Country:US
Practice Address - Phone:916-852-0149
Practice Address - Fax:916-852-8052
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26118111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor