Contract Details
Ancillary Care Services
Facility name
McIntyre Family Chiropractic and Wellness Center
Provider ID
P000004103
NPI
1245302306
Tax ID
743049446
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
1275 Powers Ferry Road Southeast Suite 300
Marietta, GA 30067
United States
County
Cobb
Phone
7709529664 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address