Provider Demographics
NPI:1760768923
Name:SHINE CHIROPRACTIC NEUROLOGY LLC
Entity Type:Organization
Organization Name:SHINE CHIROPRACTIC NEUROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC NEUROLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:SHINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC DCNBC
Authorized Official - Phone:724-834-0389
Mailing Address - Street 1:314 OLD ROUTE 30
Mailing Address - Street 2:SUITE100
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-6993
Mailing Address - Country:US
Mailing Address - Phone:724-834-0389
Mailing Address - Fax:724-834-0390
Practice Address - Street 1:314 OLD ROUTE 30
Practice Address - Street 2:SUITE100
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6993
Practice Address - Country:US
Practice Address - Phone:724-834-0389
Practice Address - Fax:724-834-0390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009205111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty