Provider Demographics
NPI:1639342413
Name:SPARKS-BECKETT, SHANA D (DC)
Entity type:Individual
Prefix:DR
First Name:SHANA
Middle Name:D
Last Name:SPARKS-BECKETT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1177 KINCROSS CT
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-6387
Mailing Address - Country:US
Mailing Address - Phone:865-441-5370
Mailing Address - Fax:
Practice Address - Street 1:4320 DEERWOOD LAKE PKWY STE 204
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1181
Practice Address - Country:US
Practice Address - Phone:904-345-4499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor