Provider Demographics
NPI:1992863393
Name:WILLIAMS, SPENCER GEYER (DC)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:GEYER
Last Name:WILLIAMS
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 1:392 FALLS AVE
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3373
Mailing Address - Country:US
Mailing Address - Phone:208-734-0500
Mailing Address - Fax:208-734-0501
Practice Address - Street 1:392 FALLS AVE
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3373
Practice Address - Country:US
Practice Address - Phone:208-734-0500
Practice Address - Fax:208-734-0501
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDC-377111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010007911OtherBLUE SHIELD
ID350043555OtherRAILROAD MEDICARE
ID381928OtherKANSAS BC BS
IDC-377OtherSTATE LICENSE
IDC7770 8E522OtherBLUE CROSS
IDT4444Medicare UPIN
ID000010007911OtherBLUE SHIELD