Almaya    Wadley    DC
Contract Details
Facility name
Provider ID
P000003649
NPI
1023249489
Tax ID
830503573
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
1121 Kinwest Pkwy Suite 100
Irving, TX 75063
United States
County
Dallas
Phone
9724012345 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address