Rodney    Gatlin    DC
Contract Details
Facility name
Provider ID
P000005008
NPI
1104909209
Tax ID
752828728
Effective Date
4/1/2012
Last Updated
5/21/2017
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
400 Boyd Court
Azle, TX 76020
United States
County
Tarrant
Phone
8174444357 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address