Provider Demographics
NPI:1013974732
Name:SPENCER, DAVEN LOWELL (DC)
Entity Type:Individual
Prefix:
First Name:DAVEN
Middle Name:LOWELL
Last Name:SPENCER
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 1:1802 ELM ST
Mailing Address - Street 2:SUITE3
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2948
Mailing Address - Country:US
Mailing Address - Phone:603-657-8460
Mailing Address - Fax:
Practice Address - Street 1:1802 ELM ST
Practice Address - Street 2:SUITE3
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2948
Practice Address - Country:US
Practice Address - Phone:603-657-8460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH830-0109111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT02-0474867OtherFED TAX ID
UT870395551SP4OtherEDUCATORS MUTUAL INS.
UT2103513OtherFIRST HEALTH
UT72478OtherPEHP
NHRE333101OtherMEDICARE
UTU54737Medicare UPIN
UT72478OtherPEHP
UTD0140Medicaid
UTHEBER VALLEY CHIROOtherDMBA
UTQM0000065877OtherALTIUS