Marilyn    Everett    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004219
NPI
1295830610
Tax ID
581681420
Effective Date
4/1/2012
Last Updated
9/26/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
111 Marbury Crossing
Tullahoma, TN 37388
United States
County
Coffee
Phone
9314550408 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address