Healthcare Provider Details

I. General information

NPI: 1013076876
Provider Name (Legal Business Name): GARY SPANIER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N HIATUS RD SUITE 101
PEMBROKE PINES FL
33026-5207
US

IV. Provider business mailing address

2802 N 46TH AVE APT B-624
HOLLYWOOD FL
33021-2927
US

V. Phone/Fax

Practice location:
  • Phone: 954-885-5656
  • Fax: 954-237-4860
Mailing address:
  • Phone: 954-885-5656
  • Fax: 954-963-3434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCH7454
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: