Provider Demographics
NPI:1205291200
Name:SHINE CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:SHINE CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORI
Authorized Official - Middle Name:R
Authorized Official - Last Name:BONITATIBUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-221-2225
Mailing Address - Street 1:870 HEBRON PKWY # 602
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-5003
Mailing Address - Country:US
Mailing Address - Phone:972-221-2225
Mailing Address - Fax:972-219-2225
Practice Address - Street 1:870 HEBRON PKWY # 602
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-5003
Practice Address - Country:US
Practice Address - Phone:972-221-2225
Practice Address - Fax:972-219-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-18
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12549111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty