Provider Demographics
NPI:1780450023
Name:SPENCE, EUGENE OLAF (LIC ACC)
Entity type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:OLAF
Last Name:SPENCE
Suffix:
Gender:M
Credentials:LIC ACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2376 HIGHTOP ROAD
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:VA
Mailing Address - Zip Code:22642
Mailing Address - Country:US
Mailing Address - Phone:540-341-4149
Mailing Address - Fax:
Practice Address - Street 1:32 WATERLOO STREET
Practice Address - Street 2:ROOM 112
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186
Practice Address - Country:US
Practice Address - Phone:540-341-4149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000109171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist