Provider Demographics
NPI:1588689707
Name:SPENCE, CHRISTOPHER M (DC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:M
Last Name:SPENCE
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 1:8555 STATION VILLAGE LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-6543
Mailing Address - Country:US
Mailing Address - Phone:619-284-3883
Mailing Address - Fax:619-295-1795
Practice Address - Street 1:8555 STATION VILLAGE LN
Practice Address - Street 2:SUITE B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-6543
Practice Address - Country:US
Practice Address - Phone:619-284-3883
Practice Address - Fax:619-295-1795
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24225111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU60402Medicare UPIN