Provider Demographics
NPI:1992954853
Name:SPICER CHIROPRACTIC PA
Entity type:Organization
Organization Name:SPICER CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:SPICER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-403-1472
Mailing Address - Street 1:1954 SAINT FRANCIS AVE
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-4308
Mailing Address - Country:US
Mailing Address - Phone:952-403-1472
Mailing Address - Fax:
Practice Address - Street 1:1954 SAINT FRANCIS AVE
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-4308
Practice Address - Country:US
Practice Address - Phone:952-403-1472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4654111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN263P1SPOtherBCBS
MN263P1SPOtherBCBS