Russel    Smith    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005537
NPI
1881728178
Tax ID
621478854
Effective Date
4/1/2012
Last Updated
9/26/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
2175 Chambliss Avenue Northwest Suite D
Cleveland, TN 37311
United States
County
Bradley
Phone
4234721140 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address