Provider Demographics
NPI:1679020432
Name:SPICEREDDY CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:SPICEREDDY CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:SPICER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:650-513-0797
Mailing Address - Street 1:25 W 25TH AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-2274
Mailing Address - Country:US
Mailing Address - Phone:650-513-0797
Mailing Address - Fax:
Practice Address - Street 1:25 W 25TH AVE STE 8
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-2274
Practice Address - Country:US
Practice Address - Phone:650-513-0797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33470OtherCALIFORNIA BOARD OF CHIROPRACTIC EXAMINERS