Provider Demographics
NPI:1316098601
Name:SPARKS, RODNEY LEE (DC)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:LEE
Last Name:SPARKS
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 1:657 LONE OAK RD
Mailing Address - Street 2:#6
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-4547
Mailing Address - Country:US
Mailing Address - Phone:270-442-4054
Mailing Address - Fax:270-442-4055
Practice Address - Street 1:657 LONE OAK RD
Practice Address - Street 2:#6
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-4547
Practice Address - Country:US
Practice Address - Phone:270-442-4054
Practice Address - Fax:270-442-4055
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4506111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100155010Medicaid
KY350051599OtherPALMETTO GBA #
KY000000197545OtherBLUE CROSS UPIN
KYTT84OtherBLUE CROSS BLUE SHIELD #
KYTT84OtherBLUE CROSS BLUE SHIELD #
KY000000197545OtherBLUE CROSS UPIN