Rick    Enlow    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004783
NPI
1548267651
Tax ID
752117596
Effective Date
4/1/2012
Last Updated
11/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
6805 Northeast Loop 820 Suite 414
Fort Worth, TX 76180
United States
County
Tarrant
Phone
8175817246 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address