Provider Demographics
NPI:1699857722
Name:SPARKS FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:SPARKS FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-689-1175
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00252111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9294651Medicare ID - Type UnspecifiedMEDICARE GROUP ID #