Contract Details
Ancillary Care Services
Facility name
Great NW Chiropractic Center
Provider ID
P000005051
NPI
1669483764
Tax ID
742684938
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
8738 Grissom Road
San Antonio, TX 78251
United States
County
Bexar
Phone
2105207833 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address