Kevin    Wheeler    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004904
NPI
1598808297
Tax ID
752661128
Effective Date
4/1/2012
Last Updated
11/11/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
314 North Grand Avenue
Gainesville, TX 76240
United States
County
Cooke
Phone
9406657656 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address