Carmen    Carlile    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000003826
NPI
1104937648
Tax ID
742635715
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
8647 Wurzbach Road Building H
San Antonio, TX 78240
United States
County
Bexar
Phone
2106410350 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address