Jon    McCreery    DC
Contract Details
Facility name
Provider ID
P000006499
Tax ID
752954621
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
88.00
Location Details
Address
1051 Haskell St Suite 107
Fort Worth, TX 76107
United States
County
Tarrant
Phone
8177386668 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address