Provider Demographics
NPI:1780699470
Name:SPENCER, RACHAEL C (LMP)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:C
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:C
Other - Last Name:RISMOEN-THRESHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:19102 SR 410 E STE A
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-8449
Mailing Address - Country:US
Mailing Address - Phone:253-863-6378
Mailing Address - Fax:
Practice Address - Street 1:19102 SR 410 E
Practice Address - Street 2:STE A
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-8449
Practice Address - Country:US
Practice Address - Phone:253-863-6378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022727225700000X
WACJ60200307111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0215365OtherLABOR AND INDUSTRIES