Provider Demographics
NPI:1235642745
Name:MARYANN GENESS
Entity Type:Organization
Organization Name:MARYANN GENESS
Other - Org Name:SPARK CHIROPRACTIC AND ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GENESS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-324-9736
Mailing Address - Street 1:PO BOX 1166
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-0039
Mailing Address - Country:US
Mailing Address - Phone:541-324-9736
Mailing Address - Fax:541-708-6261
Practice Address - Street 1:258 A ST STE 8
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1990
Practice Address - Country:US
Practice Address - Phone:541-324-9736
Practice Address - Fax:541-708-6261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3770111N00000X
ORAC160346171100000X
OR3762225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty