Provider Demographics
NPI:1760624134
Name:SPENCER, BENJAMIN ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:ALLEN
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 1:635 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4428
Mailing Address - Country:US
Mailing Address - Phone:707-304-0808
Mailing Address - Fax:707-575-5704
Practice Address - Street 1:635 5TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4428
Practice Address - Country:US
Practice Address - Phone:707-304-0808
Practice Address - Fax:707-575-5704
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 60070657111N00000X
CADC 31988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor