Contract Details
Ancillary Care Services
Facility name
Kilgore Chiropractic Clinic
Provider ID
P000005434
NPI
1821133638
Tax ID
751915982
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
316 North Henderson Boulevard
Kilgore, TX 75662
United States
County
Gregg
Phone
9039844432 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address