Provider Demographics
NPI:1841245016
Name:SPARKE, CHRISTOPHER MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:SPARKE
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 1:392 D MERROW RD
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084
Mailing Address - Country:US
Mailing Address - Phone:860-872-7771
Mailing Address - Fax:860-872-7776
Practice Address - Street 1:392 D MERROW RD
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084
Practice Address - Country:US
Practice Address - Phone:860-872-7771
Practice Address - Fax:860-872-7776
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001575111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT100575OtherCONNECTICARE
CTCTC001575OtherLANDMARK
CT050001575CT02OtherBLUE CROSS/ BLUE SHIELD
CT350001472Medicare PIN
CTCTC001575OtherLANDMARK