Eagle    Knife    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004920
NPI
1609011840
Tax ID
261991776
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
4708 West Plano Parkway Suite 300
Plano, TX 75093
United States
County
Collin
Phone
9722658103 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address