Nick    Gagich    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004801
NPI
1558305391
Tax ID
260688929
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
805 East Highway 67
Alvarado, TX 76009
United States
County
Johnson
Phone
8177833500 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address