Healthcare Provider Details

I. General information

NPI: 1376390427
Provider Name (Legal Business Name): PLUS CHIROPRACTIC&ACUPUNCTURE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/06/2024
Certification Date: 05/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6290 ABBOTTS BRIDGE RD STE 102
JOHNS CREEK GA
30097-1750
US

IV. Provider business mailing address

6290 ABBOTTS BRIDGE RD STE 102
JOHNS CREEK GA
30097-1750
US

V. Phone/Fax

Practice location:
  • Phone: 470-299-5063
  • Fax:
Mailing address:
  • Phone: 470-299-5063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: ON JOONG SHIN
Title or Position: OWNER
Credential: D.C./L.AC.
Phone: 470-299-5063