Provider Demographics
NPI:1073737326
Name:LARK, SHARON ANNE (DC)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:ANNE
Last Name:LARK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E BARSTOW AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5020
Mailing Address - Country:US
Mailing Address - Phone:559-221-6234
Mailing Address - Fax:
Practice Address - Street 1:125 E BARSTOW AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5020
Practice Address - Country:US
Practice Address - Phone:559-221-6234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19886111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC198860Medicare UPIN