Provider Demographics
NPI:1205413697
Name:BROOME, AMANDA R J (DC)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:R J
Last Name:BROOME
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CALEF ST
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4345
Mailing Address - Country:US
Mailing Address - Phone:401-921-6550
Mailing Address - Fax:401-921-6552
Practice Address - Street 1:12 CALEF ST
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4345
Practice Address - Country:US
Practice Address - Phone:401-921-6550
Practice Address - Fax:401-921-6552
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00687111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor