Jeffrey    Rodrguiez    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004842
NPI
1568680650
Tax ID
201147677
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
2351 West Northwest Highway Suite 3100
Dallas, TX 75220
United States
County
Dallas
Phone
2143623000 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address