Provider Demographics
NPI:1003614587
Name:SPRECHER, ELLIS (LAC)
Entity type:Individual
Prefix:
First Name:ELLIS
Middle Name:
Last Name:SPRECHER
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 E BLACKLIDGE DR UNIT 1
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-7400
Mailing Address - Country:US
Mailing Address - Phone:520-338-8390
Mailing Address - Fax:
Practice Address - Street 1:3024 E FORT LOWELL RD STE 101
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1572
Practice Address - Country:US
Practice Address - Phone:520-338-8390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-012236171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist