Steve    Hogan    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000003946
NPI
1174515233
Tax ID
752326051
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
1901 Coggin Avenue
Brownwood, TX 76801
United States
County
Brown
Phone
3256466944 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address