Provider Demographics
NPI:1932127081
Name:SPENCER, SONYA DENISE (DC)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:DENISE
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 1:38 PASS RD
Mailing Address - Street 2:STE.C
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-3105
Mailing Address - Country:US
Mailing Address - Phone:228-575-8660
Mailing Address - Fax:228-575-8531
Practice Address - Street 1:38 PASS RD
Practice Address - Street 2:STE.C
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-3105
Practice Address - Country:US
Practice Address - Phone:228-575-8660
Practice Address - Fax:228-575-8531
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7717111N00000X
MS1000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ110953OtherMEDICARE PTAN