Stephen    Defiore    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005477
NPI
1851490346
Tax ID
200189730
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
1407 South Bridge Street
Brady, TX 76825
United States
County
McCulloch
Phone
3255975977 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address