Lawrence    Grimm    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005500
NPI
1861637621
Tax ID
263326289
Effective Date
4/1/2012
Last Updated
10/25/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
6025 Royal Lane Suite 6051
Dallas, TX 75230
United States
County
Dallas
Phone
2146965100 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address