Brian    Nimphius    DC
Contract Details
Facility name
Provider ID
P000004636
NPI
1477735041
Tax ID
046625923
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
200 East Southlake Blvd Suite 10
Southlake, TX 76092
United States
County
Tarrant
Phone
8172516767 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address