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General NPI Number Information
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NPI Number | 1679703979
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Entity Type | Individual
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Provider Name | JAEHO SHIN D.C.
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Gender | Male
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Dates
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Enumeration Date | 07/21/2009
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Last Update Date | 04/01/2011
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Provider Practice Location Address
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Address Line | 41-10 163RD STREET 1ST FL
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City | FLUSHING
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State | NY
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Zip | 11358
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Country | US
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Telephone | 917-239-2818
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Fax | 347-732-9172
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Provider Business Mailing Address
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Address Line | 41-10 163RD STREET 1ST FL
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City | FLUSHING
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State | NY
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Zip | 11358
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Country | US
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Telephone | 917-239-2818
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Fax | 347-732-9172
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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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