Eddie    Salyer    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000003790
NPI
1083791032
Tax ID
752458122
Effective Date
4/1/2012
Last Updated
11/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
200 East Blackjack Street
Dublin, TX 76446
United States
County
Erath
Phone
2544452205 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address