Provider Demographics
NPI:1922684752
Name:SPARKS, NOAH BRYAN (DC)
Entity Type:Individual
Prefix:MR
First Name:NOAH
Middle Name:BRYAN
Last Name:SPARKS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:NOAH
Other - Middle Name:
Other - Last Name:SPARKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:6314 FM 2100 RD
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:TX
Mailing Address - Zip Code:77532-5606
Mailing Address - Country:US
Mailing Address - Phone:832-491-6026
Mailing Address - Fax:281-215-5099
Practice Address - Street 1:6314 FM 2100 RD
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:TX
Practice Address - Zip Code:77532-5606
Practice Address - Country:US
Practice Address - Phone:832-491-6026
Practice Address - Fax:281-215-5099
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14716111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor