Contract Details
Facility name
Longenecker Chiropractic Center
Provider ID
P000004711
NPI
1508942798
Tax ID
860768002
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
4020 North MacArthur Blvd Suite 102
Irving, TX 75038
United States
County
Dallas
Phone
9727172225 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address