Healthcare Provider Details

I. General information

NPI: 1619037728
Provider Name (Legal Business Name): SPERBECK ENTERPRISES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 N GRAND AVE STE 200
FORT THOMAS KY
41075-1765
US

IV. Provider business mailing address

40 N GRAND AVE STE 200
FORT THOMAS KY
41075-1765
US

V. Phone/Fax

Practice location:
  • Phone: 859-448-0900
  • Fax: 859-448-0989
Mailing address:
  • Phone: 859-448-0900
  • Fax: 859-448-0989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK JASON SPERBECK
Title or Position: OWNER
Credential: D.C., D.A.C.O.
Phone: 859-448-0900