Provider Demographics
NPI:1508057829
Name:SHIN, ON JOONG (DC/LAC)
Entity Type:Individual
Prefix:
First Name:ON JOONG
Middle Name:
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 1:6290 ABBOTTS BRIDGE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1750
Mailing Address - Country:US
Mailing Address - Phone:470-299-5063
Mailing Address - Fax:
Practice Address - Street 1:6290 ABBOTTS BRIDGE RD STE 102
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1750
Practice Address - Country:US
Practice Address - Phone:470-299-5063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA437171100000X
GACHIR010111111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist