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General NPI Number Information
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NPI Number | 1467741074
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Entity Type | Organization
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Legal Business Name | JAEHO SHIN CHIROPRACTIC, PC
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Dates
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Enumeration Date | 04/04/2011
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Last Update Date | 04/04/2011
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Provider Practice Location Address
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Address Line | 4110 163RD ST FL 1
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City | FLUSHING
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State | NY
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Zip | 11358-2606
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Country | US
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Telephone | 347-732-0396
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Fax | 347-732-9172
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Provider Business Mailing Address
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Address Line | 4110 163RD ST FL 1
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City | FLUSHING
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State | NY
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Zip | 11358-2606
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Country | US
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Telephone | 347-732-0396
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Fax | 347-732-9172
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAEHO SHIN
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Credential | DC
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Telephone | 347-732-0396
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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 | X011688
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License Number State | NY
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