Provider Demographics
NPI:1811154008
Name:BRANT D. SPENCER D.C. P.C.
Entity type:Organization
Organization Name:BRANT D. SPENCER D.C. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:BRANT
Authorized Official - Middle Name:D
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-485-9646
Mailing Address - Street 1:PO BOX 1548
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:OK
Mailing Address - Zip Code:73010-1548
Mailing Address - Country:US
Mailing Address - Phone:405-485-9646
Mailing Address - Fax:405-485-3464
Practice Address - Street 1:104 S MAIN STREET
Practice Address - Street 2:
Practice Address - City:BLANCHARD
Practice Address - State:OK
Practice Address - Zip Code:73010
Practice Address - Country:US
Practice Address - Phone:405-485-9646
Practice Address - Fax:405-485-3464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3306111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK300522151Medicare PIN