Provider Demographics
NPI:1720852437
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:DR
Authorized Official - First Name:BRAXTON
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-880-6046
Mailing Address - Street 1:1255 OLD JOLLY BAY RD UNIT B101
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:FL
Mailing Address - Zip Code:32439-4275
Mailing Address - Country:US
Mailing Address - Phone:850-880-6046
Mailing Address - Fax:
Practice Address - Street 1:1255 OLD JOLLY BAY RD UNIT B101
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:FL
Practice Address - Zip Code:32439-4275
Practice Address - Country:US
Practice Address - Phone:850-880-6046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty