Provider Demographics
NPI:1083762330
Name:SPENCER FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:SPENCER FAMILY CHIROPRACTIC, LLC
Other - Org Name:SPENCER FAMILY CHIROPRACTIC, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-577-0007
Mailing Address - Street 1:351 MORAINE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-8044
Mailing Address - Country:US
Mailing Address - Phone:970-577-0007
Mailing Address - Fax:970-577-0370
Practice Address - Street 1:351 MORAINE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-8044
Practice Address - Country:US
Practice Address - Phone:970-577-0007
Practice Address - Fax:970-577-0370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6041111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty