Grabt    Stonewell    DC
Contract Details
Facility name
Provider ID
P000003776
NPI
1083700918
Tax ID
752960514
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
9555 Lebanon Rd Suite 801
Frisco, TX 75035
United States
County
Collin
Phone
9727120200 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address