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Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005383
NPI
1801006218
Tax ID
202343961
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
5609 Southwest Green Oaks Boulevard Suite 103
Arlington, TX 76017
United States
County
Tarrant
Phone
8174833975 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address