Provider Demographics
NPI:1720395965
Name:BK CHIROPRACTIC PA
Entity Type:Organization
Organization Name:BK CHIROPRACTIC PA
Other - Org Name:CHA FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BYUNG KWON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHA
Authorized Official - Suffix:
Authorized Official - Credentials:D,C
Authorized Official - Phone:651-631-0093
Mailing Address - Street 1:1401 SILVER LAKE RD NW
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-6393
Mailing Address - Country:US
Mailing Address - Phone:651-631-0093
Mailing Address - Fax:651-631-9699
Practice Address - Street 1:1401 SILVER LAKE RD NW
Practice Address - Street 2:SUITE 4
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-6393
Practice Address - Country:US
Practice Address - Phone:651-631-0093
Practice Address - Fax:651-631-9699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNDC3927111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN302120300Medicaid
MN350002113Medicare PIN
MN302120300Medicaid