Provider Demographics
NPI:1699300046
Name:SPRADLEY, PHILIP DOYLE (DC)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:DOYLE
Last Name:SPRADLEY
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 1:4095 S STATELINE RD
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-6754
Mailing Address - Country:US
Mailing Address - Phone:208-964-8390
Mailing Address - Fax:208-773-9600
Practice Address - Street 1:1624 E SELTICE WAY
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-7022
Practice Address - Country:US
Practice Address - Phone:208-964-8390
Practice Address - Fax:208-773-9600
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHI-1977111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor