Provider Demographics
NPI:1518297860
Name:SPARKS, HOLLY (LAC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:SPARKS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ARAPAHOE STREET
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-8952
Mailing Address - Country:US
Mailing Address - Phone:719-220-0930
Mailing Address - Fax:
Practice Address - Street 1:400 W. MIDLAND AVE.
Practice Address - Street 2:STE. 203
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863
Practice Address - Country:US
Practice Address - Phone:719-220-0930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-09
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0000984171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist