Contract Details
Ancillary Care Services
Facility name
Healthsource Chiropractic & Progressive Rehab
Provider ID
P000004085
NPI
1235319351
Tax ID
331082201
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
1320 Northwest John Jones Drive
Burleson, TX 76028
United States
County
Johnson
Phone
8172977100 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address