Fredy    Romero    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005778
NPI
1992707673
Tax ID
208873067
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
110 East Savannah Avenue
McAllen, TX 78503
United States
County
Hidalgo
Phone
9566537245 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address