Mark    Bailey    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004862
NPI
1578608170
Tax ID
742884273
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
3006 Cypress Gardens
Harlingen, TX 78550
United States
County
Cameron
Phone
9564984786 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address