Provider Demographics
NPI:1558495838
Name:GREEN VALLEY CHIROPRACTIC
Entity Type:Organization
Organization Name:GREEN VALLEY CHIROPRACTIC
Other - Org Name:JOHN C SPARKS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CALHOUN
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-822-1414
Mailing Address - Street 1:3057 LORNA RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216
Mailing Address - Country:US
Mailing Address - Phone:205-822-1414
Mailing Address - Fax:205-822-1499
Practice Address - Street 1:3057 LORNA RD
Practice Address - Street 2:SUITE 105
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216
Practice Address - Country:US
Practice Address - Phone:205-822-1414
Practice Address - Fax:205-822-1499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL07001867111N00000X
AL08012735111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU50370Medicare UPIN