Provider Demographics
NPI:1295276764
Name:SPARKS, TAYLOR LEE (DC, ATC)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:LEE
Last Name:SPARKS
Suffix:
Gender:F
Credentials:DC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 ANDOVER DR
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-4359
Mailing Address - Country:US
Mailing Address - Phone:607-382-7345
Mailing Address - Fax:
Practice Address - Street 1:116 SAVANNAH AVE
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-4801
Practice Address - Country:US
Practice Address - Phone:607-382-7345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL50022255A2300X
GACHIR010508111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty