Contract Details
Ancillary Care Services
Facility name
Guajardo Chiropractic
Provider ID
P000005719
NPI
1962555391
Tax ID
043832250
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
6901 Canal Street
Houston, TX 77011
United States
County
Harris
Phone
7139286255 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address