MEDICARE: DR. MICHAELE MARIE SPARACO DC, DACNB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NN0400X	Neurology Chiropractor	9906	TX

General Provider Information

NPI Number	:	1508087636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAELE MARIE SPARACO DC, DACNB

Provider Business Mailing Address
First Line	:	3510 GALLEY RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-4312
Country	:	US
Telephone Number	:	719-380-0138
Fax Number	:	719-380-8055

Provider Business Practice Location Address
First Line	:	3510 GALLEY RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-4312
Country	:	US
Telephone Number	:	719-380-0138
Fax Number	:	719-380-8055

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	02/10/2009

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