Randy  L  Markum    DC
Contract Details
Facility name
Provider ID
P000004734
NPI
1518978956
Tax ID
752928130
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
1571 Southwest Wilshire Blvd Suite 505
Burleson, TX 76028
United States
County
Johnson
Phone
8174476400 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address