Chris    Campbell    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005795
NPI
1992962575
Tax ID
742712881
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
1470 George Dieter Drive Suite C
El Paso, TX 79936
United States
County
El Paso
Phone
9158576607 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address