Provider Demographics
NPI:1326012881
Name:ROLLINS, SPENCER L (DC)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:L
Last Name:ROLLINS
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 1:1025 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-4857
Mailing Address - Country:US
Mailing Address - Phone:801-544-4333
Mailing Address - Fax:801-544-0063
Practice Address - Street 1:1025 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4857
Practice Address - Country:US
Practice Address - Phone:801-544-4333
Practice Address - Fax:801-544-0063
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5563020-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor