Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | MC0181900 | NJ |
NPI | 1043281728 |
---|---|
Provider Name | Gary R. Spencer |
First Address | Colts Neck, NJ 07722-0538 |
Second Address | Colts Neck, NJ 07722-0538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 05/12/2007 |