Provider Demographics
NPI:1528176708
Name:SPENCER, GRANT HENRY (DC)
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:HENRY
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 1:930 BIG THOMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-8905
Mailing Address - Country:US
Mailing Address - Phone:970-646-6217
Mailing Address - Fax:
Practice Address - Street 1:930 BIG THOMPSON AVE
Practice Address - Street 2:
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-8905
Practice Address - Country:US
Practice Address - Phone:970-646-6217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO6045111N00000X
WI4117012111N00000X
CO6045111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38960400Medicaid
WI35845Medicare ID - Type Unspecified