Provider Demographics
NPI:1790020154
Name:SHIN, MIN (DC)
Entity Type:Individual
Prefix:
First Name:MIN
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 1:2828 SAFFRON DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-7504
Mailing Address - Country:US
Mailing Address - Phone:407-403-1556
Mailing Address - Fax:
Practice Address - Street 1:1310 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4244
Practice Address - Country:US
Practice Address - Phone:698-297-4723
Practice Address - Fax:321-300-0771
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-11
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11177111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor