Provider Demographics
NPI:1871964312
Name:SPARACINO, KRISTOPHER JOSEPH (LAC)
Entity type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:JOSEPH
Last Name:SPARACINO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WORTHLEY ST
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-2311
Mailing Address - Country:US
Mailing Address - Phone:908-461-2140
Mailing Address - Fax:
Practice Address - Street 1:21 WORTHLEY ST
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2311
Practice Address - Country:US
Practice Address - Phone:908-461-2140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ001148000171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist