Provider Demographics
NPI:1841256138
Name:SPENCER, VICKIE RENEE (DC)
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:RENEE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:VICKIE
Other - Middle Name:RENEE
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2314 GULL RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1432
Mailing Address - Country:US
Mailing Address - Phone:269-459-1339
Mailing Address - Fax:236-459-1340
Practice Address - Street 1:2314 GULL RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1432
Practice Address - Country:US
Practice Address - Phone:269-459-1339
Practice Address - Fax:236-459-1340
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4930150Medicaid
MI950C950530OtherBCBS
MI4930150Medicaid
MI950C950530OtherBCBS