Gregory Gary    Johnson    DC
Contract Details
Facility name
Provider ID
P000004027
NPI
1215085634
Tax ID
752963828
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
270 South Collins Rd Suite 200
Sunnyvale, TX 75182
United States
County
Dallas
Phone
9722264444 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address