Contract Details
Ancillary Care Services
Facility name
Locascio Care Clinic
Provider ID
P000004815
NPI
1558441501
Tax ID
203061197
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
433 West 12th Street
Dallas, TX 75208
United States
County
Dallas
Phone
2149437799 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address