Contract Details
Facility name
Perry Chiropractic Clinic
Provider ID
P000004477
NPI
1417093295
Tax ID
760238305
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
1001 Fairmont Pkwy Suite M
Pasadena, TX 77504
United States
County
Harris
Phone
7139461441 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address