Provider Demographics
NPI:1275630311
Name:SPARKS CHIROPRACTIC SERVICES PA
Entity Type:Organization
Organization Name:SPARKS CHIROPRACTIC SERVICES PA
Other - Org Name:SPARKS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:E
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-355-2225
Mailing Address - Street 1:3227 HENDERSON DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-5251
Mailing Address - Country:US
Mailing Address - Phone:910-355-2225
Mailing Address - Fax:910-355-2225
Practice Address - Street 1:3227 HENDERSON DR EXT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546
Practice Address - Country:US
Practice Address - Phone:910-355-2225
Practice Address - Fax:910-355-2225
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPARKS CHIROPRACTIC SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2590111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC690278AMedicaid
NCU69404Medicare UPIN
NC2344229Medicare PIN