MEDICARE: LAURIE DY'ONA CEDENO 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	11386	TX

General Provider Information

NPI Number	:	1336471598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE DY'ONA CEDENO D.C.

Provider Business Mailing Address
First Line	:	6324 MYSTIC FALLS DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-4703
Country	:	US
Telephone Number	:	817-939-2000
Fax Number	:	817-731-4858

Provider Business Practice Location Address
First Line	:	4255 BRYANT IRVIN RD
Second Line	:	STE 108
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4233
Country	:	US
Telephone Number	:	817-731-4848
Fax Number	:	817-731-4858

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

Provider Enumeration Date	:	02/12/2010
Last Update Date	:	02/12/2010

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