Jennifer    Dagnan    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004152
NPI
1265594766
Tax ID
450573744
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
107 South Story Road Suite C
Irving, TX 75060
United States
County
Dallas
Phone
9729867255 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address