Provider Demographics
NPI:1831243260
Name:SPENCER, BRIAN KEITH (DC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:KEITH
Last Name:SPENCER
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 1:75 CAVALIER BLVD STE 312
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-3963
Mailing Address - Country:US
Mailing Address - Phone:859-647-7750
Mailing Address - Fax:859-647-7750
Practice Address - Street 1:75 CAVALIER BLVD STE 312
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-3963
Practice Address - Country:US
Practice Address - Phone:859-647-7750
Practice Address - Fax:859-647-7750
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY250186111N00000X
KY4245111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0568502Medicare ID - Type UnspecifiedPROVIDERS NUMBER