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General NPI Number Information
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NPI Number | 1164618922
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Entity Type | Organization
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Legal Business Name | SHINE FOR HEALTH
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Dates
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Enumeration Date | 09/14/2007
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Last Update Date | 09/14/2007
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Provider Practice Location Address
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Address Line | 400 WILD PLUM WAY
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City | SERGEANT BLUFF
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State | IA
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Zip | 51054-3502
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Country | US
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Telephone | 712-943-1755
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Fax |
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Provider Business Mailing Address
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Address Line | 400 WILD PLUM WAY
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City | SERGEANT BLUFF
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State | IA
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Zip | 51054-3502
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Country | US
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Telephone | 712-943-1755
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL C SHINE
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Credential | D.C.
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Telephone | 712-943-1755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 06954
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License Number State | IA
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