MEDICARE: DIANE K CRIDENNDA L.AC.

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	171100000X	Acupuncturist	337	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	337	OTHER	CO	COLORADO STATE LICENCE

General Provider Information

NPI Number	:	1659493161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE K CRIDENNDA L.AC.

Provider Business Mailing Address
First Line	:	1422 N HANCOCK AVE
Second Line	:	SUITE 5 S
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-2641
Country	:	US
Telephone Number	:	719-520-5056
Fax Number	:	719-520-5222

Provider Business Practice Location Address
First Line	:	1422 N HANCOCK AVE
Second Line	:	SUITE 5 S
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-2641
Country	:	US
Telephone Number	:	719-520-5056
Fax Number	:	719-520-5222

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

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	07/08/2007

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Directions to “ DIANE K CRIDENNDA L.AC.” Practice Location

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