Provider Demographics
NPI:1770674863
Name:SPARKS, KEVIN ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ALAN
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 1:1001 MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-4139
Mailing Address - Country:US
Mailing Address - Phone:956-580-1161
Mailing Address - Fax:956-580-9992
Practice Address - Street 1:1001 MILLER AVE
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-4139
Practice Address - Country:US
Practice Address - Phone:956-580-1161
Practice Address - Fax:956-580-9992
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6335111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605034Medicare ID - Type Unspecified
TXU50686Medicare UPIN