Provider Demographics
NPI:1386720456
Name:SHIN, CHRIS SINWOOK (DC, LAC)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:SINWOOK
Last Name:SHIN
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 OCONNOR DR STE 31
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1655
Mailing Address - Country:US
Mailing Address - Phone:408-295-7380
Mailing Address - Fax:408-295-7048
Practice Address - Street 1:100 OCONNOR DR STE 31
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1655
Practice Address - Country:US
Practice Address - Phone:408-295-7380
Practice Address - Fax:408-295-7048
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25381111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor