Provider Demographics
NPI:1942262902
Name:SPICER, TOM PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:PATRICK
Last Name:SPICER
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 1:1954 SAINT FRANCIS AVE
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-4308
Mailing Address - Country:US
Mailing Address - Phone:952-403-1472
Mailing Address - Fax:
Practice Address - Street 1:1954 SAINT FRANCIS AVE
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-4308
Practice Address - Country:US
Practice Address - Phone:952-403-1472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4654111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN909608600Medicaid
MN264P1SPOtherBLUE CROSS BLUE SHIELD OF MN
MN909608600Medicaid