Contract Details
Ancillary Care Services
Facility name
Dixie Chiropractic
Provider ID
P000003742
NPI
1063678381
Tax ID
742051593
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
632 Dixie Drive
Clute, TX 77531
United States
County
Brazoria
Phone
9794800222 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address