Leif    Toombs    DC
Contract Details
Facility name
Provider ID
P000004505
NPI
1427065986
Tax ID
742204590
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
300 Airline Suite 8
Victoria, TX 77901
United States
County
Victoria
Phone
3615751021 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address