Provider Demographics
NPI:1447374996
Name:SPENCER, ROSS A (DC)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:A
Last Name:SPENCER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 MEMORIAL HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-9228
Mailing Address - Country:US
Mailing Address - Phone:570-675-3833
Mailing Address - Fax:570-675-3225
Practice Address - Street 1:3130 MEMORIAL HWY STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-9228
Practice Address - Country:US
Practice Address - Phone:570-675-3833
Practice Address - Fax:570-675-3225
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004878L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA807312OtherBLUE SHIELD
PA0012766860001Medicaid
PA807312OtherBLUE SHIELD
U28378Medicare UPIN