MEDICARE: ROY L. DEDMON

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	000444	TN

General Provider Information

NPI Number	:	1124204714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROY L. DEDMON

Provider Business Mailing Address
First Line	:	115 HIGHWAY 641 S
Second Line	:
City	:	CAMDEN
State	:	TN
Zip	:	38320-1639
Country	:	US
Telephone Number	:	731-584-7926
Fax Number	:	731-584-8192

Provider Business Practice Location Address
First Line	:	115 HIGHWAY 641 S
Second Line	:
City	:	CAMDEN
State	:	TN
Zip	:	38320-1639
Country	:	US
Telephone Number	:	731-584-7926
Fax Number	:	731-584-8192

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. ROY LANE DEDMON II
Credential	:
Telephone Number	:	731-584-7926

Provider Enumeration Date	:	01/14/2008
Last Update Date	:	01/14/2008

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