Kamyar    Ghaffari    DC
Contract Details
Facility name
Provider ID
P000005370
NPI
1790914620
Tax ID
810652032
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
3420 West Illinois Ave Suite 100A
Dallas, TX 75211
United States
County
Dallas
Phone
9724068470 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address