Provider Demographics
NPI:1093776924
Name:VAN ROMER, GARRY K (DC)
Entity Type:Individual
Prefix:DR
First Name:GARRY
Middle Name:K
Last Name:VAN ROMER
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 1:2133 BEECHER RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-2211
Mailing Address - Country:US
Mailing Address - Phone:864-985-2444
Mailing Address - Fax:
Practice Address - Street 1:2133 BEECHER RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-2211
Practice Address - Country:US
Practice Address - Phone:864-985-2444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1287111N00000X
FLCH5424111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT83738Medicare UPIN
SCT837383481Medicare UPIN