Contract Details
Ancillary Care Services
Facility name
Guajardo Chiropractic
Provider ID
P000005748
NPI
1972656197
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
1507 Gessner Drive
Houston, TX 77080
United States
County
Harris
Phone
7139286255 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address