Robert    Bergeron    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000003751
NPI
1073552733
Tax ID
751851597
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1721 South Austin Avenue
Denison, TX 75020
United States
County
Grayson
Phone
9034635151 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address