Kristal    Cooper    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004363
NPI
1366606501
Tax ID
262807938
Effective Date
4/1/2012
Last Updated
10/10/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
3801 Dylan Place Suite 110
Lexington, KY 40514
United States
County
Fayette
Phone
8592962313 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address