Provider Demographics
NPI:1699040949
Name:SPARKS CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:SPARKS CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:661-665-1800
Mailing Address - Street 1:8201 CAMINO MEDIA
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-1354
Mailing Address - Country:US
Mailing Address - Phone:661-665-1800
Mailing Address - Fax:661-765-1421
Practice Address - Street 1:8501 CAMINO MEDIA
Practice Address - Street 2:SUITE 200
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-1354
Practice Address - Country:US
Practice Address - Phone:661-665-1800
Practice Address - Fax:661-765-1421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0239910Medicare PIN
CAU77906Medicare UPIN