Larry    Warner    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005028
NPI
1659426047
Tax ID
208039071
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
6217 Chapel Hill Boulevard Suite 100
Plano, TX 75093
United States
County
Collin
Phone
9727811244 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address