Provider Demographics
NPI:1811860604
Name:SUNSHINE SPINE CLINIC PLLC
Entity type:Organization
Organization Name:SUNSHINE SPINE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAUDRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-624-1321
Mailing Address - Street 1:961687 GATEWAY BLVD STE 101B
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-9158
Mailing Address - Country:US
Mailing Address - Phone:904-624-1321
Mailing Address - Fax:904-624-1789
Practice Address - Street 1:961687 GATEWAY BLVD STE 101B
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-9158
Practice Address - Country:US
Practice Address - Phone:904-624-1321
Practice Address - Fax:904-624-1789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty