Provider Demographics
NPI:1699728303
Name:SPARKS, WILLIAM BRADFORD (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRADFORD
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 1:2103 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6459
Mailing Address - Country:US
Mailing Address - Phone:405-447-9700
Mailing Address - Fax:405-364-8788
Practice Address - Street 1:2103 W MAIN STREET
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069
Practice Address - Country:US
Practice Address - Phone:405-447-9700
Practice Address - Fax:405-447-9769
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK3290111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U60985Medicare UPIN