Mark    Hembree    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000003605
NPI
1003876830
Tax ID
201860414
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1904 West Grande Boulevard
Tyler, TX 75703
United States
County
Smith
Phone
9035610086 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address