Eulalia    Johnson    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005431
NPI
1821092719
Tax ID
752639347
Effective Date
4/1/2012
Last Updated
11/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1409 West Moore Avenue
Terrell, TX 75160
United States
County
Kaufman
Phone
9725631557 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address