Carol  E  Grennan    DC
Contract Details
Facility name
Provider ID
P000004318
NPI
1346250602
Tax ID
752957853
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
7447 MacArthur Blvd Suite 180
Irving, TX 75063
United States
County
Dallas
Phone
9722531500 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address