Kirk    Rexroat    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004767
NPI
1538368030
Tax ID
260185846
Effective Date
4/1/2012
Last Updated
10/23/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
100 Country Club Road Suite 107
Argyle, TX 76226
United States
County
Denton
Phone
9404642273 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address