MEDICARE: DR. THERESA SPENCER D.C

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	007690	IA

General Provider Information

NPI Number	:	1194110809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERESA SPENCER D.C

Provider Business Mailing Address
First Line	:	1104 25TH AVE N
Second Line	:
City	:	CLINTON
State	:	IA
Zip	:	52732-1906
Country	:	US
Telephone Number	:	563-249-3391
Fax Number	:

Provider Business Practice Location Address
First Line	:	1732 S WASHINGTON BLVD
Second Line	:
City	:	CAMANCHE
State	:	IA
Zip	:	52730-1713
Country	:	US
Telephone Number	:	563-249-3391
Fax Number	:

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

Provider Enumeration Date	:	03/30/2015
Last Update Date	:	03/30/2015

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