Provider Demographics
NPI:1962436212
Name:SPENCER CHIROPRACTIC CLINIC INC.
Entity type:Organization
Organization Name:SPENCER CHIROPRACTIC CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-649-3662
Mailing Address - Street 1:203 S CANDY LN
Mailing Address - Street 2:STE. 2B
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4120
Mailing Address - Country:US
Mailing Address - Phone:928-649-3662
Mailing Address - Fax:928-649-0967
Practice Address - Street 1:203 S CANDY LN
Practice Address - Street 2:STE 2B
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4120
Practice Address - Country:US
Practice Address - Phone:928-649-3662
Practice Address - Fax:928-649-0967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSU87588Medicare UPIN
MS350000309Medicare ID - Type Unspecified