Healthcare Provider Details

I. General information

NPI: 1053215244
Provider Name (Legal Business Name): SHINE CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13621 ROOSEVELT AVE STE 204
FLUSHING NY
11354-5507
US

IV. Provider business mailing address

13621 ROOSEVELT AVE STE 204
FLUSHING NY
11354-5507
US

V. Phone/Fax

Practice location:
  • Phone: 718-516-1888
  • Fax: 718-516-2888
Mailing address:
  • Phone: 718-516-1888
  • Fax: 718-516-2888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: EDWIN THOMPSON
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 718-516-1888