Provider Demographics
NPI:1346571254
Name:SPARKS, BRANDI L (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDI
Middle Name:L
Last Name:SPARKS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 MAIN ST W
Mailing Address - Street 2:PO BOX 73
Mailing Address - City:STATE CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50247-7777
Mailing Address - Country:US
Mailing Address - Phone:641-483-3051
Mailing Address - Fax:641-483-3052
Practice Address - Street 1:114 MAIN ST W
Practice Address - Street 2:
Practice Address - City:STATE CENTER
Practice Address - State:IA
Practice Address - Zip Code:50247-7777
Practice Address - Country:US
Practice Address - Phone:641-483-3051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-18
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011557111N00000X
IA007449111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor