Provider Demographics
NPI:1609972355
Name:ROMO, EDGAR (DC)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:
Last Name:ROMO
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 1:2813 COFFEE RD STE F
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-1755
Mailing Address - Country:US
Mailing Address - Phone:209-571-1999
Mailing Address - Fax:
Practice Address - Street 1:2813 COFFEE RD STE F
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-1755
Practice Address - Country:US
Practice Address - Phone:209-571-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor