Provider Demographics
NPI:1467510339
Name:SPENCER, ADAM ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:ROBERT
Last Name:SPENCER
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 1:2707 E FREMONT ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95205-3936
Mailing Address - Country:US
Mailing Address - Phone:209-463-6639
Mailing Address - Fax:209-463-8452
Practice Address - Street 1:2707 E FREMONT ST
Practice Address - Street 2:SUITE 6
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205-3936
Practice Address - Country:US
Practice Address - Phone:209-463-6639
Practice Address - Fax:209-463-8452
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 29150111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC029150Medicare ID - Type Unspecified
CAU98666Medicare UPIN