Provider Demographics
NPI:1497977664
Name:SPORE, RAYMOND WENDELL JR (DC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:WENDELL
Last Name:SPORE
Suffix:JR
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 1:515 G ST
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-3820
Mailing Address - Country:US
Mailing Address - Phone:530-758-5554
Mailing Address - Fax:
Practice Address - Street 1:515 G ST
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-3820
Practice Address - Country:US
Practice Address - Phone:530-758-5554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18262111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor