Contract Details
Ancillary Care Services
Facility name
Champions Clinic
Provider ID
P000005264
NPI
1750467247
Tax ID
200463454
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
2934 Kemp Boulevard
Wichita Falls, TX 76308
United States
County
Wichita
Phone
9407200800 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address