Provider Demographics
NPI:1508892332
Name:SPARKS, ROBERT SCOTT (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:SCOTT
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 1:365 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3845
Mailing Address - Country:US
Mailing Address - Phone:740-689-1175
Mailing Address - Fax:740-689-1178
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:740-689-1178
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2069111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000121709OtherANTHEM PIN
OHU50839Medicare UPIN