Kimberly    Junemann    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004045
NPI
1225023062
Tax ID
752509201
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
2708 Southwest Parkway Suite A-121
Wichita Falls, TX 76308
United States
County
Wichita
Phone
9406968184 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address