Robert    Brady    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004183
NPI
1275715807
Tax ID
562464126
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
2929 Custer Road Suite 320
Plano, TX 75075
United States
County
Collin
Phone
9728678500 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address