MEDICARE: DR. DIA GAYBRIELLE DODSON-HARDEMAN 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	9445	TX

General Provider Information

NPI Number	:	1811992118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIA GAYBRIELLE DODSON-HARDEMAN D.C.

Provider Business Mailing Address
First Line	:	311 LAFAYETTE ST
Second Line	:
City	:	PITTSBURG
State	:	TX
Zip	:	75686-1709
Country	:	US
Telephone Number	:	903-856-7771
Fax Number	:	903-856-7772

Provider Business Practice Location Address
First Line	:	311 LAFAYETTE ST
Second Line	:
City	:	PITTSBURG
State	:	TX
Zip	:	75686-1709
Country	:	US
Telephone Number	:	903-856-7771
Fax Number	:	903-856-7772

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	08/01/2012

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