Ogechi    Guinness    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005493
NPI
1861552861
Tax ID
352324819
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
9304 Forest Lane Suite 108
Dallas, TX 75243
United States
County
Dallas
Phone
9722170079 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address