MEDICARE: SPENCER TRETTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	15818	FL

General Provider Information

NPI Number	:	1255287165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SPENCER TRETTER

Provider Business Mailing Address
First Line	:	1307 CREPE MYRTLE LN
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-7396
Country	:	US
Telephone Number	:	724-713-8183
Fax Number	:

Provider Business Practice Location Address
First Line	:	1307 CREPE MYRTLE LN
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-7396
Country	:	US
Telephone Number	:	724-713-8183
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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Directions to “ SPENCER TRETTER ” Practice Location

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