MEDICARE: DR. DIANA E SPENCER DC

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	DC .4043 DC	SC

General Provider Information

NPI Number	:	1346620630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANA E SPENCER DC

Provider Business Mailing Address
First Line	:	3070 N HIGHWAY 17
Second Line	:	STE 200
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-9300
Country	:	US
Telephone Number	:	843-352-2180
Fax Number	:	843-352-2192

Provider Business Practice Location Address
First Line	:	3070 N HIGHWAY 17
Second Line	:	STE 200
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-9300
Country	:	US
Telephone Number	:	843-352-2180
Fax Number	:	843-352-2192

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

Provider Enumeration Date	:	06/02/2015
Last Update Date	:	06/02/2015

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Directions to “ DR. DIANA E SPENCER DC” Practice Location

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