Provider Demographics
NPI:1316493299
Name:SPENCER, ERICA L (L AC)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:L
Last Name:SPENCER
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1282 WATERLOO GENEVA RD
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NY
Mailing Address - Zip Code:13165-1208
Mailing Address - Country:US
Mailing Address - Phone:607-684-3423
Mailing Address - Fax:315-539-4684
Practice Address - Street 1:1282 WATERLOO GENEVA RD
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NY
Practice Address - Zip Code:13165-1208
Practice Address - Country:US
Practice Address - Phone:607-684-3423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005757171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist