Provider Demographics
NPI:1053771881
Name:SPICZENSKI, ANDREW
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:SPICZENSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:CO
Mailing Address - Zip Code:80542-0278
Mailing Address - Country:US
Mailing Address - Phone:970-535-9900
Mailing Address - Fax:888-915-3313
Practice Address - Street 1:209 MAIN STREET
Practice Address - Street 2:E
Practice Address - City:MEAD
Practice Address - State:CO
Practice Address - Zip Code:80542
Practice Address - Country:US
Practice Address - Phone:970-535-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012804111N00000X
COCHR.0007418111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor