Melissa    Faulkenberry    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004239
NPI
1306815303
Tax ID
010636503
Effective Date
4/1/2012
Last Updated
10/18/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
11125 Arcade Drive Suite D
Little Rock, AR 72212
United States
County
Pulaski
Phone
5012251371 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address