Todd Oliver    Whipple    DC
Contract Details
Facility name
Provider ID
P000005308
NPI
1770622748
Tax ID
830347967
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
4613 Bee Caves Rd Suite 102
Austin, TX 78746
United States
County
Travis
Phone
5124480900 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address