Provider Demographics
NPI:1144612029
Name:SHIN, SEBASTIAN SEUNGHOON (DC)
Entity Type:Individual
Prefix:
First Name:SEBASTIAN
Middle Name:SEUNGHOON
Last Name:SHIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1349 W CHELTENHAM AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-3141
Mailing Address - Country:US
Mailing Address - Phone:267-607-1875
Mailing Address - Fax:267-214-1155
Practice Address - Street 1:1349 W CHELTENHAM AVE STE 201
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-3141
Practice Address - Country:US
Practice Address - Phone:267-607-1875
Practice Address - Fax:267-214-1155
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010837111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor