Mark    Hanson    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005220
NPI
1730189903
Tax ID
260348590
Effective Date
4/1/2012
Last Updated
10/23/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
11461 North Stemmons Freeway Suite 241
Dallas, TX 75229
United States
County
Dallas
Phone
2146163355 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address