Provider Demographics
NPI:1457647489
Name:CHENEY, SPENCER D (DC)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:D
Last Name:CHENEY
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 1:1121 E 3900 S STE 125
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1261
Mailing Address - Country:US
Mailing Address - Phone:801-747-0770
Mailing Address - Fax:
Practice Address - Street 1:1121 E 3900 S STE 125
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1261
Practice Address - Country:US
Practice Address - Phone:801-747-0770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5309691-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT45-4686762OtherTAX ID NUMBER