Provider Demographics
NPI:1467060475
Name:SHIN, DANIEL MYEONGCHULL (DC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:MYEONGCHULL
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 1:6800 PITTSFORD PALMYRA RD STE 420
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3520
Mailing Address - Country:US
Mailing Address - Phone:585-598-3458
Mailing Address - Fax:585-598-3459
Practice Address - Street 1:6800 PITTSFORD PALMYRA RD STE 420
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3520
Practice Address - Country:US
Practice Address - Phone:585-598-3458
Practice Address - Fax:585-598-3459
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14922229111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor