Individual
MARK A SPENCER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DN
Contact information
Practice address
15850 NEW AVE, LEMONT, IL 60439-3680
(815) 302-2784
(630) 243-8807
Mailing address
15850 NEW AVE, LEMONT, IL 60439-3680
(815) 302-2784
(630) 243-8807
Taxonomy
Speciality
Code
Description
License number
State
111NN0400X
Neurology Chiropractor
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02232712
BLUE CROSS BLUE SHIELD IL
IL
Enumeration date
12/29/2006
Last updated
07/08/2007
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