Provider Demographics
NPI:1508919457
Name:SPREARE, NATHANIEL PHELPS (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:PHELPS
Last Name:SPREARE
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 1:412 VETERANS RD STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-1507
Mailing Address - Country:US
Mailing Address - Phone:803-776-0550
Mailing Address - Fax:803-776-0425
Practice Address - Street 1:412 VETERANS RD STE A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1507
Practice Address - Country:US
Practice Address - Phone:803-776-0550
Practice Address - Fax:803-776-0425
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC959111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT 25063Medicare ID - Type Unspecified# OF REFERRING PHYSICIAN