Provider Demographics
NPI:1194110809
Name:SPENCER, THERESA (DC)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:
Last Name:SPENCER
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 1:1104 25TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-1906
Mailing Address - Country:US
Mailing Address - Phone:563-249-3391
Mailing Address - Fax:
Practice Address - Street 1:1732 S WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CAMANCHE
Practice Address - State:IA
Practice Address - Zip Code:52730-1713
Practice Address - Country:US
Practice Address - Phone:563-249-3391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007690111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor