Contract Details
Ancillary Care Services
Facility name
Chiropractic & Sports Clinic
Provider ID
P000004745
NPI
1528268695
Tax ID
752231604
Effective Date
4/1/2012
Last Updated
11/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1649 West Henderson Street Suite A
Cleburne, TX 76033
United States
County
Johnson
Phone
8176414042 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address