Darran    Marlow    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004002
NPI
1194965269
Tax ID
264234323
Effective Date
4/1/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
6020 West Parker Road Suite 420
Plano, TX 75093
United States
County
Collin
Phone
9726085087 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address