MEDICARE: SEUNGMOOK SHIN DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC010156	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104150077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEUNGMOOK SHIN DC

Provider Business Mailing Address
First Line	:	1200 WELSH RD # F2
Second Line	:
City	:	NORTH WALES
State	:	PA
Zip	:	19454-3771
Country	:	US
Telephone Number	:	215-647-2188
Fax Number	:	215-647-2943

Provider Business Practice Location Address
First Line	:	1200 WELSH RD # F2
Second Line	:
City	:	NORTH WALES
State	:	PA
Zip	:	19454-3771
Country	:	US
Telephone Number	:	215-647-2188
Fax Number	:	215-647-2943

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2009
Last Update Date	:	07/21/2022

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Directions to “ SEUNGMOOK SHIN DC” Practice Location

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