Provider Demographics
NPI:1265518088
Name:SPICER, MARY C (DC)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:C
Last Name:SPICER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5247 SHELBURNE RD.
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482
Mailing Address - Country:US
Mailing Address - Phone:802-985-3300
Mailing Address - Fax:802-735-0454
Practice Address - Street 1:5247 SHELBURNE RD.
Practice Address - Street 2:SUITE 204
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482
Practice Address - Country:US
Practice Address - Phone:802-985-3300
Practice Address - Fax:802-735-0454
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006-0000899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0002856OtherMEDICARE PTAN
VT00018435OtherBLUE CROSS/BLUE SHIELD
VT00018435OtherBLUE CROSS/BLUE SHIELD
VT0002856OtherMEDICARE PTAN