Amina    Khan    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005098
NPI
1689759607
Tax ID
204709945
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
1750 North Collins Boulevard Suite 103
Richardson, TX 75080
United States
County
Dallas
Phone
9722311717 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address