MEDICARE: DR. SEAN MATTHEW DUNIVENT 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	2005026319	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5762118	OTHER	MO	COVNTRY
2	7398818	OTHER	MO	AETNA
3	7245620	OTHER	MO	AETNA PPO
4	36352029	OTHER	MO	BCBS

General Provider Information

NPI Number	:	1619026275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN MATTHEW DUNIVENT D.C.

Provider Business Mailing Address
First Line	:	9205 NE HIGHWAY 152
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64158-7608
Country	:	US
Telephone Number	:	816-781-2090
Fax Number	:	816-781-2092

Provider Business Practice Location Address
First Line	:	9205 NE HIGHWAY 152
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64158-7608
Country	:	US
Telephone Number	:	816-781-2090
Fax Number	:	816-781-2092

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	03/15/2008

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