Provider Demographics
NPI:1467565952
Name:SPOONER, SAMANTHA JO (DC)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:JO
Last Name:SPOONER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:258 JAMES ST STE 10
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-1826
Mailing Address - Country:US
Mailing Address - Phone:616-396-6635
Mailing Address - Fax:616-396-6679
Practice Address - Street 1:258 JAMES ST STE 10
Practice Address - Street 2:SUITE B
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-1826
Practice Address - Country:US
Practice Address - Phone:616-396-6635
Practice Address - Fax:616-396-6679
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009163111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor