Provider Demographics
NPI:1508639113
Name:SHIN, MICHELLE (DC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SHIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 WESTRIDGE AVE W APT V206
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98466-1886
Mailing Address - Country:US
Mailing Address - Phone:201-663-3737
Mailing Address - Fax:
Practice Address - Street 1:2310 MILDRED ST W STE 130
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98466-6055
Practice Address - Country:US
Practice Address - Phone:253-460-4244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61496939111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor