Joshua    Auzenne    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005310
NPI
1770626228
Tax ID
208154538
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
7460 Golden Pond Place Suite 300
Amarillo, TX 79121
United States
County
Randall
Phone
8063675000 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address