Provider Demographics
NPI:1164878450
Name:SPARKS, EDWARD (DC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
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 1:1155 S DALE MABRY HWY
Mailing Address - Street 2:UNIT 8
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-5035
Mailing Address - Country:US
Mailing Address - Phone:813-207-5027
Mailing Address - Fax:
Practice Address - Street 1:1155 S DALE MABRY HWY
Practice Address - Street 2:UNIT 8
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5035
Practice Address - Country:US
Practice Address - Phone:813-207-5027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 11822111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor