Ronald    Faries    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004364
NPI
1366607699
Tax ID
731726610
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
426 Keller Parkway
Keller, TX 76248
United States
County
Tarrant
Phone
8174310507 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address