Provider Demographics
NPI:1134276249
Name:SUNSHINE, BRIAN W (DC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:W
Last Name:SUNSHINE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804
Mailing Address - Country:US
Mailing Address - Phone:865-977-9028
Mailing Address - Fax:865-984-9986
Practice Address - Street 1:380 HIGH ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5846
Practice Address - Country:US
Practice Address - Phone:865-984-6850
Practice Address - Fax:865-984-9986
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC 1142111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3677439Medicare ID - Type Unspecified
TNU 52199Medicare UPIN