Provider Demographics
NPI:1356820716
Name:SPURLOCK, ELIZABETH ANNE DAVIES (LAC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE DAVIES
Last Name:SPURLOCK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 AVON RD
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:94707-1301
Mailing Address - Country:US
Mailing Address - Phone:510-860-1280
Mailing Address - Fax:
Practice Address - Street 1:1834 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-1516
Practice Address - Country:US
Practice Address - Phone:510-845-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17807171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist