Provider Demographics
NPI:1265924724
Name:SPENCER, DANIEL JOHN (DPM)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JOHN
Last Name:SPENCER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 MILLIKEN CT
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-2808
Mailing Address - Country:US
Mailing Address - Phone:832-457-7730
Mailing Address - Fax:
Practice Address - Street 1:4001 W ROYAL DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-8965
Practice Address - Country:US
Practice Address - Phone:231-935-0666
Practice Address - Fax:231-935-1660
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-31
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT36-2018213E00000X
MI5901400398213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist