Martin    Andries    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005324
NPI
1780629972
Tax ID
721075763
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
316 West Panola Street
Carthage, TX 75633
United States
County
Panola
Phone
9036938338 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address