John    Scott    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005203
NPI
1720192982
Tax ID
752502575
Effective Date
4/1/2012
Last Updated
11/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
2603 Cherry Lane
Fort Worth, TX 76116
United States
County
Tarrant
Phone
8175601625 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address