Jose    Alvarez    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005018
NPI
1659329035
Tax ID
581765393
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
3424 Flat Shoals Road
Decatur, GA 30034
United States
County
DeKalb
Phone
4042415304 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address