Dean    Allen    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005068
NPI
1679564025
Tax ID
690011420
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
800 Ira East Woods Avenue
Grapevine, TX 76051
United States
County
Tarrant
Phone
8174817025 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address