Philip    Roberts    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005052
NPI
1669522355
Tax ID
202709637
Effective Date
4/1/2012
Last Updated
10/21/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
302 North Greenwood Avenue
Fort Smith, AR 72901
United States
County
Sebastian
Phone
4797829505 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address