Contract Details
Advanced Spine & Sports Medicine
Facility name
Advanced Spine & Sports Medicine
Provider ID
P000004718
NPI
1518086925
Tax ID
752847336
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
4801 Spring Valley Rd Suite 40
Dallas, TX 75244
United States
County
Dallas
Phone
9724889686 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address