Provider Demographics
NPI:1972605608
Name:SPAUR, PHILLIP MANSFIELD (DC)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:MANSFIELD
Last Name:SPAUR
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:PO BOX 30
Mailing Address - Street 2:346 EAST 3RD STREET
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452
Mailing Address - Country:US
Mailing Address - Phone:304-269-5253
Mailing Address - Fax:304-269-5253
Practice Address - Street 1:346 EAST 3RD STREET
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452
Practice Address - Country:US
Practice Address - Phone:304-269-5253
Practice Address - Fax:304-269-5253
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV538111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7600046Medicaid
WV7600046Medicaid
U12803Medicare UPIN