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John
Burley
DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000006430
Tax ID
460511798
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
205 Gifford Place
Joelton, TN 37080
United States
County
Davidson
Phone
6158769936
(
Phone
)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address