MEDICARE: DR. SAMUEL SOO AHN 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	11211	TX

General Provider Information

NPI Number	:	1447489984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL SOO AHN D.C.

Provider Business Mailing Address
First Line	:	2710 N STEMMONS FWY
Second Line	:	SUITE 101
City	:	DALLAS
State	:	TX
Zip	:	75207-2210
Country	:	US
Telephone Number	:	214-905-4999
Fax Number	:	214-905-4999

Provider Business Practice Location Address
First Line	:	2710 N STEMMONS FWY
Second Line	:	SUITE 101
City	:	DALLAS
State	:	TX
Zip	:	75207-2210
Country	:	US
Telephone Number	:	214-905-4999
Fax Number	:	214-905-4999

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

Provider Enumeration Date	:	07/06/2009
Last Update Date	:	03/03/2011

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