MEDICARE: SBC CHIROPRACTIC CLINIC, INC

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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01635320	OTHER	IL	BLUECROSS BLUE SHIELD

General Provider Information

NPI Number	:	1336361815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SBC CHIROPRACTIC CLINIC, INC

Provider Business Mailing Address
First Line	:	325 N MILWAUKEE AVE
Second Line	:	SUITE B
City	:	WHEELING
State	:	IL
Zip	:	60090-3071
Country	:	US
Telephone Number	:	847-541-3456
Fax Number	:	847-541-3656

Provider Business Practice Location Address
First Line	:	325 N MILWAUKEE AVE
Second Line	:	SUITE B
City	:	WHEELING
State	:	IL
Zip	:	60090-3071
Country	:	US
Telephone Number	:	847-541-3456
Fax Number	:	847-541-3656

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BYUNG KWAN CHUN
Credential	:	D.C.
Telephone Number	:	847-541-3456

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	08/22/2020

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