Contract Details
Facility name
Park West Chiropractic & Rehab Center
Provider ID
P000005426
NPI
1821051541
Tax ID
752617758
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
2750 William D Tate Ave Suite 200
Grapevine, TX 76051
United States
County
Tarrant
Phone
8174818060 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address