Contract Details
Ancillary Care Services
Facility name
Baker Chiropractic
Provider ID
P000004993
NPI
1639360068
Tax ID
203564625
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
317 North High Street
Longview, TX 75601
United States
County
Gregg
Phone
9037535400 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address