Provider Demographics
NPI:1497836852
Name:SPARKS, LAURA SUE (DC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:SUE
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 1:6622 KING ARTHURS CT
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:OH
Mailing Address - Zip Code:43112-9788
Mailing Address - Country:US
Mailing Address - Phone:740-756-7462
Mailing Address - Fax:
Practice Address - Street 1:365 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3845
Practice Address - Country:US
Practice Address - Phone:740-689-1175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2155111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0140903Medicaid
OH31-1551369-00Medicare UPIN
OH0140903Medicaid