John    Parker    DC
Contract Details
Facility name
Provider ID
P000004755
NPI
1538170337
Tax ID
752883573
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
3719 North Belt Line Rd
Irving, TX 75038
United States
County
Dallas
Phone
9722554443 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address