Stephen    Unterse    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004548
NPI
1447212501
Tax ID
742725711
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
6955 North Mesa Street Suite 103
El Paso, TX 79912
United States
County
El Paso
Phone
9158453033 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address