MEDICARE: KYU CHEOL MUN D.C.

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	10-04929	KS
2	111N00000X	Chiropractor	2004092660	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35118011	OTHER	MO	BLUE CROSS BLUE SHIELD
2	5598644	OTHER	KS	FIRST HEALTH

General Provider Information

NPI Number	:	1043390727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYU CHEOL MUN D.C.

Provider Business Mailing Address
First Line	:	8014 STATE LINE RD
Second Line	:	SUITE 101
City	:	LEAWOOD
State	:	KS
Zip	:	66208
Country	:	US
Telephone Number	:	913-341-1930
Fax Number	:	913-341-1960

Provider Business Practice Location Address
First Line	:	8014 STATE LINE RD
Second Line	:	SUITE 101
City	:	LEAWOOD
State	:	KS
Zip	:	66208
Country	:	US
Telephone Number	:	913-341-1930
Fax Number	:	913-341-1960

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/08/2007

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