MEDICARE: DR. CHUN Y THAM DC

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	CH 60119619	WA
2	111N00000X	Chiropractor	273269	OR
3	111N00000X	Chiropractor	CHIA 1275	ID
4	111N00000X	Chiropractor	11917	TX

General Provider Information

NPI Number	:	1740264142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHUN Y THAM DC

Provider Business Mailing Address
First Line	:	14855 BLANCO RD STE 310
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-7731
Country	:	US
Telephone Number	:	210-281-4188
Fax Number	:	210-281-4195

Provider Business Practice Location Address
First Line	:	14855 BLANCO RD STE 310
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-7731
Country	:	US
Telephone Number	:	210-281-4188
Fax Number	:	210-281-4195

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	07/21/2022

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Directions to “ DR. CHUN Y THAM DC” Practice Location

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