Provider Demographics
NPI:1245807205
Name:SPEARES CHIROPRACTIC AND SPORTS CARE LLC
Entity Type:Organization
Organization Name:SPEARES CHIROPRACTIC AND SPORTS CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:PHILLIPS
Authorized Official - Last Name:SPEARES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:804-784-0161
Mailing Address - Street 1:115 BROAD STREET RD
Mailing Address - Street 2:
Mailing Address - City:MANAKIN SABOT
Mailing Address - State:VA
Mailing Address - Zip Code:23103-2272
Mailing Address - Country:US
Mailing Address - Phone:804-784-0161
Mailing Address - Fax:
Practice Address - Street 1:115 BROAD STREET RD
Practice Address - Street 2:
Practice Address - City:MANAKIN SABOT
Practice Address - State:VA
Practice Address - Zip Code:23103-2272
Practice Address - Country:US
Practice Address - Phone:804-784-0161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty