Provider Demographics
NPI:1346595410
Name:BROOME, CLAYTON LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:LEE
Last Name:BROOME
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 777
Mailing Address - Street 2:
Mailing Address - City:ROEBUCK
Mailing Address - State:SC
Mailing Address - Zip Code:29376-0777
Mailing Address - Country:US
Mailing Address - Phone:864-707-0123
Mailing Address - Fax:864-272-3987
Practice Address - Street 1:1400 JOHN B WHITE SR BLVD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-3927
Practice Address - Country:US
Practice Address - Phone:864-707-0123
Practice Address - Fax:864-752-9443
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3754111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH375Medicaid
SCAA9510AMedicare PIN