Todd    Porter    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000003798
NPI
1093700270
Tax ID
752557698
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
2317 West University Drive
Denton, TX 76201
United States
County
Denton
Phone
9403870405 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address