Contract Details
Facility name
Premier Chiropractic
Provider ID
P000004740
NPI
1528145174
Tax ID
760580645
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
2018 East Broadway St
Pearland, TX 77581
United States
County
Brazoria
Phone
2814852955 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address