Provider Demographics
NPI:1558826495
Name:SPARKS, FLINT RYAN (DC)
Entity Type:Individual
Prefix:
First Name:FLINT
Middle Name:RYAN
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 1:2117 YARBROUGH DR
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:75409-5534
Mailing Address - Country:US
Mailing Address - Phone:918-510-6673
Mailing Address - Fax:
Practice Address - Street 1:2016 W WHITE ST STE 400
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:TX
Practice Address - Zip Code:75409-5171
Practice Address - Country:US
Practice Address - Phone:918-510-6673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-05
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13933111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor