Provider Demographics
NPI:1417033200
Name:SHIN, RAYMOND (DC)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
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 1:37450 GARFIELD RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-3657
Mailing Address - Country:US
Mailing Address - Phone:586-226-3724
Mailing Address - Fax:586-226-9605
Practice Address - Street 1:37450 GARFIELD RD
Practice Address - Street 2:SUITE 250
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48036-3657
Practice Address - Country:US
Practice Address - Phone:586-226-3724
Practice Address - Fax:586-226-9605
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRS007001111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIRS007001OtherLICENSE
MIU54403Medicare UPIN