Kana    Haddock    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004003
NPI
1205061637
Tax ID
264513226
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
5020 50th Street Suite 101
Lubbock, TX 79414
United States
County
Lubbock
Phone
8067714774 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address