Provider Demographics
NPI:1992872097
Name:SPARKS, JOHN CALHOUN (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CALHOUN
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 1:3057 LORNA RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-4514
Mailing Address - Country:US
Mailing Address - Phone:205-822-1414
Mailing Address - Fax:205-822-1499
Practice Address - Street 1:3057 LORNA RD
Practice Address - Street 2:SUITE 105
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216-4514
Practice Address - Country:US
Practice Address - Phone:205-822-1414
Practice Address - Fax:205-822-1499
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL07001867111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU50370Medicare UPIN