Provider Demographics
NPI:1407052152
Name:SPENCE, JOHN REXFORD (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:REXFORD
Last Name:SPENCE
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 1:1 BARNEY RD
Mailing Address - Street 2:STE. 108
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-5843
Mailing Address - Country:US
Mailing Address - Phone:518-348-1935
Mailing Address - Fax:518-348-1936
Practice Address - Street 1:1 BARNEY RD
Practice Address - Street 2:STE. 108
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-5843
Practice Address - Country:US
Practice Address - Phone:518-348-1935
Practice Address - Fax:518-348-1936
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0058821111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC058828-8OtherNYS WORKERS' COMPENSATION
NY10018818OtherCDPHP
NYC058828-8OtherNYS WORKERS' COMPENSATION
NYU02502Medicare UPIN