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General NPI Number Information
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NPI Number | 1962840330
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Entity Type | Organization
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Legal Business Name | SPARC CHIROPRACTIC, P.C.
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Dates
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Enumeration Date | 06/07/2013
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Last Update Date | 06/22/2013
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Provider Practice Location Address
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Address Line | 800-2 FRONTENAC ROAD #2
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City | AURORA
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State | IL
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Zip | 60504
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Country | US
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Telephone | 630-854-3245
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Fax |
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Provider Business Mailing Address
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Address Line | 4308 CHESAPEAK DRIVE #3D
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City | AURORA
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State | IL
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Zip | 60504
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. MICHAEL QUINTANA
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Credential | D.C.
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Telephone | 630-649-0620
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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 | 038.012439
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License Number State | IL
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