Provider Demographics
NPI:1801088398
Name:SUNSHINE CHIROPRACTIC CENTER, PC.
Entity type:Organization
Organization Name:SUNSHINE CHIROPRACTIC CENTER, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VENUS
Authorized Official - Middle Name:CRYSTAL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-347-5169
Mailing Address - Street 1:PO BOX 1894
Mailing Address - Street 2:
Mailing Address - City:BANDON
Mailing Address - State:OR
Mailing Address - Zip Code:97411-1894
Mailing Address - Country:US
Mailing Address - Phone:541-347-5169
Mailing Address - Fax:
Practice Address - Street 1:780 2ND ST SE STE 6
Practice Address - Street 2:
Practice Address - City:BANDON
Practice Address - State:OR
Practice Address - Zip Code:97411-8354
Practice Address - Country:US
Practice Address - Phone:541-347-5169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273028111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty