Provider Demographics
NPI:1821355983
Name:SPENCER, NAN EVANS (DC)
Entity Type:Individual
Prefix:
First Name:NAN
Middle Name:EVANS
Last Name:SPENCER
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 1:1070 KAINS AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-2242
Mailing Address - Country:US
Mailing Address - Phone:510-528-4283
Mailing Address - Fax:
Practice Address - Street 1:1070 KAINS AVE
Practice Address - Street 2:APT 1
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-2242
Practice Address - Country:US
Practice Address - Phone:510-528-4283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25104111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor