Randall    Schulze    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004764
NPI
1538323381
Tax ID
742627149
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
11924 Vance Jackson Road Suite 104
San Antonio, TX 78230
United States
County
Bexar
Phone
2106965150 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address