Healthcare Provider Details

I. General information

NPI: 1558354084
Provider Name (Legal Business Name): MARK A SPENCER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 07/19/2020
Certification Date: 07/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 US HIGHWAY 68
MAYSVILLE KY
41056-9132
US

IV. Provider business mailing address

103 DUNN CIR
GEORGETOWN KY
40324-8796
US

V. Phone/Fax

Practice location:
  • Phone: 606-564-4213
  • Fax: 606-564-4406
Mailing address:
  • Phone: 727-644-4064
  • Fax: 502-212-4334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number9819
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2916
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number250032
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: