Kent    Noell    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005732
NPI
1972538320
Tax ID
751784952
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
88.00
Location Details
Address
326 Edmonds Lane Suite 104
Lewisville, TX 75067
United States
County
Denton
Phone
9405663232 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address