Walter Joseph    Hart    DC
Contract Details
Facility name
Provider ID
P000003606
NPI
1003880543
Tax ID
752771832
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
17194 Preston Rd Suite 120
Dallas, TX 75248
United States
County
Dallas
Phone
9729318777 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address