Mary Jo    Ellig    DC
Contract Details
Facility name
Provider ID
P000005726
NPI
1962717041
Tax ID
752832908
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
2221 Cross Timbers Rd Suite 137
Flower Mound, TX 75028
United States
County
Denton
Phone
9727247247 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address