MEDICARE: JEFFREY KWAN PREMIER CHIROPRACTIC

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	DC30676	CA

General Provider Information

NPI Number	:	1346615119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY KWAN PREMIER CHIROPRACTIC

Provider Business Mailing Address
First Line	:	411 E HUNTINGTON DR STE 119
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91006-3788
Country	:	US
Telephone Number	:	626-888-1773
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 E HUNTINGTON DR STE 119
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91006-3788
Country	:	US
Telephone Number	:	626-888-1773
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. JEFFREY KWAN
Credential	:	DC
Telephone Number	:	626-888-1773

Provider Enumeration Date	:	12/04/2015
Last Update Date	:	12/04/2015

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