Provider Demographics
NPI:1649596651
Name:THROM, PETER A (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
Last Name:THROM
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 1:605 S 24TH AVE
Mailing Address - Street 2:SUITE 46
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-1705
Mailing Address - Country:US
Mailing Address - Phone:715-301-1111
Mailing Address - Fax:
Practice Address - Street 1:605 S 24TH AVE
Practice Address - Street 2:SUITE 46
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-1705
Practice Address - Country:US
Practice Address - Phone:715-301-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4621-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor