Gerald    Farris    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000003976
NPI
1184710253
Tax ID
751423676
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
3110 Gilmer Road
Longview, TX 75604
United States
County
Gregg
Phone
9037593651 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address