MEDICARE: JULIO C FAJARDO 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	9155	TX

General Provider Information

NPI Number	:	1649205568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIO C FAJARDO D.C.

Provider Business Mailing Address
First Line	:	6316 AZLE AVE
Second Line	:	STE 600
City	:	FORT WORTH
State	:	TX
Zip	:	76135-2442
Country	:	US
Telephone Number	:	817-237-5900
Fax Number	:	817-238-6318

Provider Business Practice Location Address
First Line	:	6316 AZLE AVE
Second Line	:	STE 600
City	:	FORT WORTH
State	:	TX
Zip	:	76135-2442
Country	:	US
Telephone Number	:	817-237-5900
Fax Number	:	817-238-6318

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	06/20/2008

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