Provider Demographics
NPI:1942821368
Name:STARK CHIROPRACTIC & SPORTS, PLLC
Entity Type:Organization
Organization Name:STARK CHIROPRACTIC & SPORTS, PLLC
Other - Org Name:STARK CHIROPRACTIC & SPORTS, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:STARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCSP, ICSC, EMT
Authorized Official - Phone:281-547-8930
Mailing Address - Street 1:5625 FM 1960 RD W STE 400
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-4211
Mailing Address - Country:US
Mailing Address - Phone:281-836-5908
Mailing Address - Fax:281-836-5909
Practice Address - Street 1:8500 CYPRESSWOOD DR STE 207
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-7105
Practice Address - Country:US
Practice Address - Phone:281-547-8930
Practice Address - Fax:281-547-8931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-27
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4132961Medicaid