Provider Demographics
NPI:1588795777
Name:SPOHN-CARLE, MARY T A (DOM, LAC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:T A
Last Name:SPOHN-CARLE
Suffix:
Gender:F
Credentials:DOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12611 N 103RD AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3422
Mailing Address - Country:US
Mailing Address - Phone:623-815-3306
Mailing Address - Fax:623-815-6848
Practice Address - Street 1:12611 N 103RD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3422
Practice Address - Country:US
Practice Address - Phone:623-815-3306
Practice Address - Fax:623-815-6848
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0141171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist