Provider Demographics
NPI:1477517936
Name:SPARKS, CLAYTON E (DC)
Entity Type:Individual
Prefix:MR
First Name:CLAYTON
Middle Name:E
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 1:3227 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:910-938-2225
Practice Address - Street 1:3227 HENDERSON DRIVE 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:910-938-2225
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2590111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890838Medicaid
NC890838VMedicaid
NC890838Medicaid
NC890838VMedicaid
NC2453239Medicare PIN