Provider Demographics
NPI:1477961274
Name:SPENCER CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:SPENCER CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVEN
Authorized Official - Middle Name:LOWELL
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:603-657-8460
Mailing Address - Street 1:1802 ELM ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2948
Mailing Address - Country:US
Mailing Address - Phone:603-657-8460
Mailing Address - Fax:
Practice Address - Street 1:1802 ELM ST
Practice Address - Street 2:SUITE 3
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2948
Practice Address - Country:US
Practice Address - Phone:603-657-8460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH830-0109111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE333101OtherMEDICARE