Contract Details
Ancillary Care Services
Facility name
Pain Relief Rehab
Provider ID
P000004813
NPI
1558396820
Tax ID
571195036
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
363 West Main Street
Lewisville, TX 75057
United States
County
Denton
Phone
9724364434 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address