Provider Demographics
NPI:1841205580
Name:SHIN, SOON Y (DC)
Entity Type:Individual
Prefix:MR
First Name:SOON
Middle Name:Y
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 1:8437 STATE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-1842
Mailing Address - Country:US
Mailing Address - Phone:913-299-0276
Mailing Address - Fax:913-299-3775
Practice Address - Street 1:8437 STATE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-1842
Practice Address - Country:US
Practice Address - Phone:913-299-0276
Practice Address - Fax:913-299-3775
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-00760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor