Provider Demographics
NPI:1598873671
Name:SPENCER SMITH, ERIN (DC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:SPENCER SMITH
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 1:435 RIVERCREST COURT
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-1759
Mailing Address - Country:US
Mailing Address - Phone:262-363-9552
Mailing Address - Fax:262-363-9556
Practice Address - Street 1:435 RIVERCREST CT
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-1759
Practice Address - Country:US
Practice Address - Phone:262-363-9552
Practice Address - Fax:262-363-9556
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3244111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38971800Medicaid
WI35845Medicare ID - Type Unspecified