Edward    Wilson    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004470
NPI
1417030685
Tax ID
272204599
Effective Date
4/1/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
4500 Hillcrest Road Suite 160
Frisco, TX 75035
United States
County
Collin
Phone
9723774747 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address