MEDICARE: DR. GIDEON TRAWEEK 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	10322	TX

General Provider Information

NPI Number	:	1295966133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GIDEON TRAWEEK D.C.

Provider Business Mailing Address
First Line	:	PO BOX 121309
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76121-1305
Country	:	US
Telephone Number	:	817-498-7333
Fax Number	:	817-581-2866

Provider Business Practice Location Address
First Line	:	3625 WESTERN CENTER BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1936
Country	:	US
Telephone Number	:	817-498-7333
Fax Number	:	817-581-2866

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

Provider Enumeration Date	:	07/27/2009
Last Update Date	:	07/27/2009

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