Healthcare Provider Details

I. General information

NPI: 1699728303
Provider Name (Legal Business Name): WILLIAM BRADFORD SPARKS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 W MAIN STREET
NORMAN OK
73069
US

IV. Provider business mailing address

2103 W MAIN ST
NORMAN OK
73069-6459
US

V. Phone/Fax

Practice location:
  • Phone: 405-447-9700
  • Fax: 405-447-9769
Mailing address:
  • Phone: 405-447-9700
  • Fax: 405-364-8788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberOK3290
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: