Provider Demographics
NPI:1336471598
Name:CEDENO, LAURIE DY'ONA (DC)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:DY'ONA
Last Name:CEDENO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6324 MYSTIC FALLS DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-4703
Mailing Address - Country:US
Mailing Address - Phone:817-939-2000
Mailing Address - Fax:817-731-4858
Practice Address - Street 1:4255 BRYANT IRVIN RD
Practice Address - Street 2:STE 108
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4233
Practice Address - Country:US
Practice Address - Phone:817-731-4848
Practice Address - Fax:817-731-4858
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11386111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor