Provider Demographics
NPI:1346620630
Name:SPENCER, DIANA E (DC)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:E
Last Name:SPENCER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3070 N HIGHWAY 17
Mailing Address - Street 2:STE 200
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-9300
Mailing Address - Country:US
Mailing Address - Phone:843-352-2180
Mailing Address - Fax:843-352-2192
Practice Address - Street 1:3070 N HIGHWAY 17
Practice Address - Street 2:STE 200
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-9300
Practice Address - Country:US
Practice Address - Phone:843-352-2180
Practice Address - Fax:843-352-2192
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDC .4043 DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor