Provider Demographics
NPI:1366912917
Name:SPARKLE CITY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:SPARKLE CITY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:K
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-450-7708
Mailing Address - Street 1:PO BOX 907
Mailing Address - Street 2:
Mailing Address - City:DRAYTON
Mailing Address - State:SC
Mailing Address - Zip Code:29333-0719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1802 DRAYTON RD STE 309
Practice Address - Street 2:
Practice Address - City:DRAYTON
Practice Address - State:SC
Practice Address - Zip Code:29333-7002
Practice Address - Country:US
Practice Address - Phone:843-450-7708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty