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General NPI Number Information
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NPI Number | 1841015500
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Entity Type | Organization
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Legal Business Name | SPARK CHIROPRACTIC WELLNESS PLLC
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 28 SENECA ST
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City | GENEVA
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State | NY
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Zip | 14456-3501
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Country | US
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Telephone | 315-563-5494
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Fax |
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Provider Business Mailing Address
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Address Line | 2346 LOWER LAKE RD
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City | SENECA FALLS
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State | NY
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Zip | 13148-9417
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Country | US
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Telephone | 315-879-4054
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Fax |
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Authorized Official
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Title or Position | SOLE OWNER
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Name | ALEXANDRIA ARUCK
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Credential | DC
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Telephone | 315-563-5494
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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 |
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License Number State |
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