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General NPI Number Information
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NPI Number | 1962436212
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Entity Type | Organization
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Legal Business Name | SPENCER CHIROPRACTIC CLINIC INC.
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 05/27/2009
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Provider Practice Location Address
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Address Line | 203 S CANDY LN STE 2B
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City | COTTONWOOD
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State | AZ
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Zip | 86326-4120
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Country | US
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Telephone | 928-649-3662
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Fax | 928-649-0967
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Provider Business Mailing Address
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Address Line | 203 S CANDY LN STE. 2B
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City | COTTONWOOD
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State | AZ
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Zip | 86326-4120
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Country | US
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Telephone | 928-649-3662
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Fax | 928-649-0967
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Authorized Official
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Title or Position | PRESIDENT
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Name | SONYA DENISE SPENCER
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Credential | D.C.
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Telephone | 928-649-3662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1000
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License Number State | MS
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