Beau William Sparks, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

6035 Issued in OR

Practice address

1421 N Meadowwood LN Ste 80
Liberty Lake, WA 99019-6021

Phone

(360) 980-0614

NPI assigned

Oct 25, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Liberty Chiropractic LLC

  • Chiropractor
  • Liberty Lake, WA
  • NPI 1942076807
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1571961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702857600000",
    "number": "1265075964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1421 N MEADOWWOOD LN STE 80",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990196021",
            "telephone_number": "360-980-0614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1421 N MEADOWWOOD LN STE 80",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990196021",
            "telephone_number": "360-980-0614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPARKS",
        "first_name": "BEAU",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-10-25",
        "last_updated": "2023-12-18",
        "certification_date": "2023-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "6035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cameron Simonds
• Alex Sizov, LMT
• Diana Lynn Smith, PHYSICAL THERAPIST
• Kelsey Alexis Smith, RN, IBCLC
• Marc James Soelberg, DDS
• Emily Stark, LMHCA
• Steven O Thomas MD
• Patrick Michael Stewart, MA
• Paula Marie Stiles, P.T.
• Stronghold Family Counseling

• Chiropractor in Liberty Lake, WA
• Providers in Liberty Lake, WA by specialty
• Chiropractor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.