MEDICARE: JILL SUNWHA HERMEN DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4597	MN
2	111N00000X	Chiropractor	DC26201	CA

General Provider Information

NPI Number	:	1912998055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL SUNWHA HERMEN DC

Provider Business Mailing Address
First Line	:	825 NICOLLET MALL
Second Line	:	SUITE 1845
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55402-2606
Country	:	US
Telephone Number	:	612-339-0149
Fax Number	:	612-332-5972

Provider Business Practice Location Address
First Line	:	825 NICOLLET MALL
Second Line	:	SUITE 1845
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55402-2606
Country	:	US
Telephone Number	:	612-339-0149
Fax Number	:	612-332-5972

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	07/08/2007

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