Provider Demographics
NPI:1194121533
Name:SPENCER, NATHAN A (DC)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:A
Last Name:SPENCER
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 1:2150 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-4402
Mailing Address - Country:US
Mailing Address - Phone:209-527-8560
Mailing Address - Fax:209-527-0837
Practice Address - Street 1:2150 SCENIC DR
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4402
Practice Address - Country:US
Practice Address - Phone:209-527-8560
Practice Address - Fax:209-527-0837
Is Sole Proprietor?:No
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 32943111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC 32943Medicare PIN