Provider Demographics
NPI:1235284688
Name:SPARKS CHIROPRACTIC INC
Entity Type:Organization
Organization Name:SPARKS CHIROPRACTIC INC
Other - Org Name:SEAVIEW CHIROPRACTIC OR SPARKS CHIROPRACTIC HEALTH CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-938-3175
Mailing Address - Street 1:4208 SW OREGON ST.
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116
Mailing Address - Country:US
Mailing Address - Phone:206-938-3175
Mailing Address - Fax:206-938-1848
Practice Address - Street 1:4208 SW OREGON ST.
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116
Practice Address - Country:US
Practice Address - Phone:206-938-3175
Practice Address - Fax:206-938-1848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2106111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0046125OtherDEPT. OF L&I
WA4210SPOtherREGENCE BLUE SHIELD