Contract Details
Ancillary Care Services
Facility name
Healthsource of Allen
Provider ID
P000003987
NPI
1184991069
Tax ID
453036840
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
1546 East Stacy Road Suite 170
Allen, TX 75002
United States
County
Collin
Phone
9723591362 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address