Robert Lee    Mabry    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000003828
NPI
1104986249
Tax ID
680525639
Effective Date
4/1/2012
Last Updated
9/26/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
301 Church Street
Nashville, TN 37201
United States
County
Davidson
Phone
6152557900 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address