MEDICARE: DR. BYUNG KWON CHA 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	DC3927	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669565560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BYUNG KWON CHA D.C.

Provider Business Mailing Address
First Line	:	1401 SILVER LAKE RD NW
Second Line	:	SUITE 4
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-9307
Country	:	US
Telephone Number	:	651-631-0093
Fax Number	:	651-631-9699

Provider Business Practice Location Address
First Line	:	1401 SILVER LAKE RD NW
Second Line	:	SUITE 4
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-9307
Country	:	US
Telephone Number	:	651-631-0093
Fax Number	:	651-631-9699

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	10/15/2011

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