Shad    Reif    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004432
NPI
1396841664
Tax ID
260333644
Effective Date
4/1/2012
Last Updated
10/23/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
114 South Jackson Avenue
Wylie, TX 75098
United States
County
Collin
Phone
9724294677 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address