Troy    Allam    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005089
NPI
1689675209
Tax ID
203468630
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
2300 McDermott Road Suite 200
Plano, TX 75025
United States
County
Collin
Phone
2146440810 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address