Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 3754 | SC |
Y | 111NR0400X | Rehabilitation Chiropractor | 3754 | SC |
NPI | 1346595410 |
---|---|
Provider Name | Dr. Clayton Lee Broome |
First Address | Spartanburg, SC 29302-2174 |
Second Address | Spartanburg, SC 29302-2148 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2012 |
Last Update Date | 12/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CH375 | (05) | SC |