Spencer Reece Brauchla, DC
Individual provider Active NPI Chiropractor · Laotto, IN
NPI 1164053773 · NPPES record last updated Feb 1, 2020
Key facts
- NPI
- 1164053773
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 08003146A (IN)
- Practice address
- 6265 E 400 S
Laotto, IN 46763-9772 - Phone
- (260) 318-5285
- NPI assigned
- Feb 1, 2020
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 7
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Other, 2019
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Crossroads Wellness Center, LLC
Neighborhood Health Clinics Inc
Practice addresses (Care Compare)
12812 Coldwater Rd
Suite 101
Fort Wayne, IN 46845-9516
Phone (260) 445-8389
1717 S Calhoun St
Fort Wayne, IN 46802-5257
1721 S Calhoun St
Neighborhood Health Clinics Inc
Fort Wayne, IN 46802-5257
Phone (260) 458-2641
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210312000186 | IN | Practitioner - Chiropractic | 7012323249 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 08003146A | IN | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Burns Physical Therapy and Wellness Company | Current |
Accepting new patients | |
| Neighborhood Health Clinics, Inc | Current |
Accepting new patients | |
| Neighborhood Health Clinics, Inc | Current |
Accepting new patients | |
| Crossroads Wellness Center, LLC | Chiropractor | Current |
Accepting new patients |
Locations
12812 Coldwater Rd
#101
Fort Wayne, IN 46845
Phone (260) 445-8389
1717 S Calhoun St
Fort Wayne, IN 46802
Phone (260) 458-2641
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 08003146A | IN | Yes |
Addresses
Primary practice location
6265 E 400 S
Laotto, IN 46763-9772
Mailing address
6265 E 400 S
Laotto, IN 46763-9772
Phone (260) 318-5285
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 08003146A | Other | IN | INDIANA STATE CHIROPRACTIC LICENSE NUMBER |
Other providers in Laotto, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 1, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.