MEDICARE: DR. ROSS A 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	DC004878L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	807312	OTHER	PA	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447374996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSS A SPENCER DC

Provider Business Mailing Address
First Line	:	3130 MEMORIAL HWY STE 100
Second Line	:
City	:	DALLAS
State	:	PA
Zip	:	18612-9228
Country	:	US
Telephone Number	:	570-675-3833
Fax Number	:	570-675-3225

Provider Business Practice Location Address
First Line	:	3130 MEMORIAL HWY STE 100
Second Line	:
City	:	DALLAS
State	:	PA
Zip	:	18612-9228
Country	:	US
Telephone Number	:	570-675-3833
Fax Number	:	570-675-3225

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	10/05/2011

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Directions to “ DR. ROSS A SPENCER DC” Practice Location

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