Michael    Leath    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004649
NPI
1487653499
Tax ID
751635502
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
327 North Grand Avenue
Waxahachie, TX 75165
United States
County
Ellis
Phone
9729371470 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address