Provider Demographics
NPI:1598385122
Name:SPORE, LAUREN (DC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:SPORE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-4447
Mailing Address - Country:US
Mailing Address - Phone:620-792-3678
Mailing Address - Fax:620-792-3670
Practice Address - Street 1:1302 W 7TH ST
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NE
Practice Address - Zip Code:68787-1692
Practice Address - Country:US
Practice Address - Phone:402-375-3450
Practice Address - Fax:402-375-3450
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2035111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor