Michael    Hogan    DC
Contract Details
Facility name
Provider ID
P000004506
NPI
1427067313
Tax ID
636763116
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
8700 West Main St Suite 130
Frisco, TX 75034
United States
County
Denton
Phone
4696330123 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address