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General NPI Number Information
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NPI Number | 1639342413
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Entity Type | Individual
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Provider Name | SHANA D SPARKS-BECKETT DC
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Gender | Female
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Dates
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Enumeration Date | 04/11/2008
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 4320 DEERWOOD LAKE PKWY STE 204
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City | JACKSONVILLE
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State | FL
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Zip | 32216-1181
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Country | US
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Telephone | 904-345-4499
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Fax |
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Provider Business Mailing Address
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Address Line | 1177 KINCROSS CT
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City | ORANGE PARK
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State | FL
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Zip | 32065-6387
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Country | US
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Telephone | 865-441-5370
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH14107
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License Number State | FL
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