Provider Demographics
NPI:1841015500
Name:SPARK CHIROPRACTIC WELLNESS PLLC
Entity type:Organization
Organization Name:SPARK CHIROPRACTIC WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARUCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-563-5494
Mailing Address - Street 1:2346 LOWER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SENECA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13148-9417
Mailing Address - Country:US
Mailing Address - Phone:315-879-4054
Mailing Address - Fax:
Practice Address - Street 1:28 SENECA ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-3501
Practice Address - Country:US
Practice Address - Phone:315-563-5494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty