Contract Details
Ancillary Care Services
Facility name
Blue Print To Wellness
Provider ID
P000005294
NPI
1760631527
Tax ID
271764275
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
305 Cimarron Trail Suite 108
Irving, TX 75063
United States
County
Dallas
Phone
9724090016 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address