MEDICARE: DR. CRAIG ERIC CERNOSEK 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	DC7394	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC7394	OTHER	TX	LICENSE NUMBER

General Provider Information

NPI Number	:	1194738252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG ERIC CERNOSEK D.C.

Provider Business Mailing Address
First Line	:	1411 N VALLEY MILLS DR
Second Line	:	SUITE H
City	:	WACO
State	:	TX
Zip	:	76710-4460
Country	:	US
Telephone Number	:	254-772-6579
Fax Number	:	254-772-6584

Provider Business Practice Location Address
First Line	:	1411 N VALLEY MILLS DR
Second Line	:	SUITE H
City	:	WACO
State	:	TX
Zip	:	76710-4460
Country	:	US
Telephone Number	:	254-772-6579
Fax Number	:	254-772-6584

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. CRAIG ERIC CERNOSEK D.C.” Practice Location

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