Provider Demographics
NPI:1558354084
Name:SPENCER, MARK A (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
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 1:103 DUNN CIR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8796
Mailing Address - Country:US
Mailing Address - Phone:727-644-4064
Mailing Address - Fax:502-212-4334
Practice Address - Street 1:1335 US HIGHWAY 68
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-9132
Practice Address - Country:US
Practice Address - Phone:606-564-4213
Practice Address - Fax:606-564-4406
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2020-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9819111N00000X
OH2916111N00000X
KY250032111N00000X
KY25003111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000360683OtherANTHEM PIN
KY7100098410Medicaid
KY1179081OtherCHA PIN
KY6079912OtherMEDICARE ID-TYPE UNSPECIFIED
KY6059115Medicare ID - Type Unspecified