Contract Details
Ancillary Care Services
Facility name
Healthsource Chiropractic & Progressive Rehab of Cedar Park
Provider ID
P000004845
NPI
1568738508
Tax ID
454722372
Effective Date
7/26/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
201 South Lakeline Boulevard Suite 204
Cedar Park, TX 78613
United States
County
Williamson
Phone
5125016941 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address