Derek    Totty    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005697
NPI
1952442360
Tax ID
621142551
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
4765 Andrew Jackson Parkway
Hermitage, TN 37076
United States
County
Davidson
Phone
6158831020 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address