Contract Details
Ancillary Care Services
Facility name
Backworx of Dallas
Provider ID
P000004398
NPI
1386677094
Tax ID
200701790
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
3116 Martin Luther King, Jr. Boulevard
Dallas, TX 75215
United States
County
Dallas
Phone
2149566995 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address