Provider Demographics
NPI:1700022555
Name:BA REUN HEALTH CENTER LLC
Entity Type:Organization
Organization Name:BA REUN HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-418-1110
Mailing Address - Street 1:3230 STEVE REYNOLDS BLVD
Mailing Address - Street 2:#208
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8839
Mailing Address - Country:US
Mailing Address - Phone:770-418-1110
Mailing Address - Fax:
Practice Address - Street 1:3230 STEVE REYNOLDS BLVD
Practice Address - Street 2:#208
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8839
Practice Address - Country:US
Practice Address - Phone:770-418-1110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty