Provider Demographics
NPI:1194750174
Name:PELLEGRINI, JAMES MASON (DC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MASON
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 1:524 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-3936
Mailing Address - Country:US
Mailing Address - Phone:262-353-3733
Mailing Address - Fax:
Practice Address - Street 1:7929 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53217
Practice Address - Country:US
Practice Address - Phone:414-351-6766
Practice Address - Fax:414-351-6735
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1978111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38906500Medicaid