Provider Demographics
NPI:1922803766
Name:WICHERT, SPENCER (DC)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:WICHERT
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 1:1544 MINT RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-0024
Mailing Address - Country:US
Mailing Address - Phone:913-205-3357
Mailing Address - Fax:
Practice Address - Street 1:520 N STATE ROAD 135 STE R
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1321
Practice Address - Country:US
Practice Address - Phone:317-893-2853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003494A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor