Brock    Lovett    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004852
NPI
1578537593
Tax ID
751788750
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
2203 Paramount Boulevard
Amarillo, TX 79109
United States
County
Randall
Phone
8063587106 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address