Provider Demographics
NPI:1780821496
Name:ROM, PETER CLAYTON (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:CLAYTON
Last Name:ROM
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 1:50955 HAYES RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-3237
Mailing Address - Country:US
Mailing Address - Phone:586-532-7732
Mailing Address - Fax:586-532-7734
Practice Address - Street 1:50955 HAYES RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-3237
Practice Address - Country:US
Practice Address - Phone:586-532-7732
Practice Address - Fax:586-532-7734
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009532111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor