Sharon    Dunagan    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000003909
NPI
1144376526
Tax ID
752619484
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
2940 Broadway Boulevard Suite 110
Garland, TX 75041
United States
County
Dallas
Phone
9726444744 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address