Larry    McIlroy    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005405
NPI
1801990957
Tax ID
459907141
Effective Date
4/1/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
111 John Dupre Drive
Levelland, TX 79336
United States
County
Hockley
Phone
8068948119 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address