Contract Details
Ancillary Care Services
Facility name
Elandary Wellness & Injury Chiropractic
Provider ID
P000004529
NPI
1437161916
Tax ID
510588964
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
9780 LBJ Freeway Suite 103
Dallas, TX 75243
United States
County
Dallas
Phone
2143349293 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address