Provider Demographics
NPI:1114098860
Name:SPARKS, KEITH LEROY (DC)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:LEROY
Last Name:SPARKS
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 1:8201 CAMINO MEDIA
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-1354
Mailing Address - Country:US
Mailing Address - Phone:661-665-1800
Mailing Address - Fax:661-765-1421
Practice Address - Street 1:8201 CAMINO MEDIA
Practice Address - Street 2:SUITE 200
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-1354
Practice Address - Country:US
Practice Address - Phone:661-665-1800
Practice Address - Fax:661-765-1421
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23991111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0239910Medicare ID - Type Unspecified
CAU77906Medicare UPIN