Provider Demographics
NPI:1669565560
Name:CHA, BYUNG KWON (DC)
Entity type:Individual
Prefix:DR
First Name:BYUNG KWON
Middle Name:
Last Name:CHA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:55112-9307
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:55112-9307
Practice Address - Country:US
Practice Address - Phone:651-631-0093
Practice Address - Fax:651-631-9699
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNDC3927111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN302120300Medicaid
MNU80492Medicare UPIN
MN302120300Medicaid