Provider Demographics
NPI:1285328773
Name:GODARD, SPENCER (DC)
Entity type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:
Last Name:GODARD
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 OLD OAK DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-5636
Mailing Address - Country:US
Mailing Address - Phone:469-251-0338
Mailing Address - Fax:
Practice Address - Street 1:211 MAIN ST STE 150
Practice Address - Street 2:
Practice Address - City:LAKE DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75065-3729
Practice Address - Country:US
Practice Address - Phone:469-251-0338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15488111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty