Michael    Goad    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004279
NPI
1326071218
Tax ID
710891397
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
967 Pruitt Place
Tyler, TX 75703
United States
County
Smith
Phone
9722451315 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address