Provider Demographics
NPI:1093711210
Name:BARON, SPENCER H (DC)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:H
Last Name:BARON
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 1:1948 NE 123RD ST
Mailing Address - Street 2:STE 107
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2800
Mailing Address - Country:US
Mailing Address - Phone:305-891-2520
Mailing Address - Fax:305-891-5754
Practice Address - Street 1:1948 NE 123RD ST
Practice Address - Street 2:STE 107
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2800
Practice Address - Country:US
Practice Address - Phone:305-891-2520
Practice Address - Fax:305-891-5754
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
FLCH5188111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T85526Medicare UPIN
FL70901YMedicare ID - Type Unspecified