Ben    Trowbridge    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005661
NPI
1942237557
Tax ID
751889866
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
2112 West Beauregard Avenue
San Angelo, TX 76901
United States
County
Tom Green
Phone
3259427661 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address