Troy  G  Shannon    DC
Contract Details
Facility name
Provider ID
P000004632
NPI
1477699403
Tax ID
752730746
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
3008 East Hwy 377
Granbury, TX 76049
United States
County
Hood
Phone
8135739009 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address