David    Blatchley    DC
Contract Details
Facility name
Provider ID
P000005204
NPI
1720195654
Tax ID
743100766
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
211 South Hwy 183
Leander, TX 78641
United States
County
Williamson
Phone
5122593547 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address