Ana Cobian    Silver    DC
Contract Details
Facility name
Provider ID
P000005059
NPI
1669694105
Tax ID
752668439
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
220 North Zang Blvd
Dallas, TX 75208
United States
County
Dallas
Phone
2149421212 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address