MEDICARE: SPICEREDDY CHIROPRACTIC, INC

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	261QH0100X	Health Service Clinic/Center
2	111N00000X	Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	33470	OTHER	CA	CALIFORNIA BOARD OF CHIROPRACTIC EXAMINERS

General Provider Information

NPI Number	:	1679020432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPICEREDDY CHIROPRACTIC, INC

Provider Business Mailing Address
First Line	:	25 W 25TH AVE STE 8
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94403-2274
Country	:	US
Telephone Number	:	650-513-0797
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 W 25TH AVE STE 8
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94403-2274
Country	:	US
Telephone Number	:	650-513-0797
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARGARET SPICER
Credential	:	DC
Telephone Number	:	650-513-0797

Provider Enumeration Date	:	09/08/2016
Last Update Date	:	08/14/2022

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Directions to “SPICEREDDY CHIROPRACTIC, INC ” Practice Location

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