Contract Details
Ancillary Care Services
Facility name
Back In Motion Family Chiropractic
Provider ID
P000005666
NPI
1942255500
Tax ID
330996604
Effective Date
4/1/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
104 Grapevine Highway Suite 400
Hurst, TX 76054
United States
County
Tarrant
Phone
8174852400 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address