John Ryan    Price    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004383
NPI
1376690834
Tax ID
204564902
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
601 East Southlake Boulevard Suite 200
Southlake, TX 76092
United States
County
Tarrant
Phone
8179123331 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address