Contract Details
Ancillary Care Services
Facility name
Healthsource of Highland Park
Provider ID
P000003836
NPI
1114160827
Tax ID
263807606
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
3408 Milton Avenue
Dallas, TX 75205
United States
County
Dallas
Phone
2147392225 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address