MEDICARE: DR. MYRON CONVERSE 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	4053	KS

General Provider Information

NPI Number	:	1134131139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MYRON CONVERSE DC

Provider Business Mailing Address
First Line	:	627 COURT ST
Second Line	:
City	:	CLAY CENTER
State	:	KS
Zip	:	67432-2607
Country	:	US
Telephone Number	:	785-632-2211
Fax Number	:

Provider Business Practice Location Address
First Line	:	1034 W 8TH ST
Second Line	:
City	:	JUNCTION CITY
State	:	KS
Zip	:	66441-2168
Country	:	US
Telephone Number	:	785-238-5240
Fax Number	:

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	09/08/2011

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