Provider Demographics
NPI:1245683028
Name:SPANOVICH, ADAM RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:RICHARD
Last Name:SPANOVICH
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 1:7345 GRISSOM PKWY
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-3260
Mailing Address - Country:US
Mailing Address - Phone:740-391-5063
Mailing Address - Fax:
Practice Address - Street 1:2351 W EAU GALLIE BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3114
Practice Address - Country:US
Practice Address - Phone:321-622-6610
Practice Address - Fax:321-622-6716
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor