Joseph    Ysbrnad    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000003663
NPI
1033225461
Tax ID
201051130
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
3304 Southeast Loop 20
Fort Worth, TX 76140
United States
County
Tarrant
Phone
8176158633 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address