Vernon    Bryder    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004124
NPI
1255357141
Tax ID
752627719
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
105 West 7th Avenue Suite 100
Corsicana, TX 75110
United States
County
Navarro
Phone
9038729122 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address