Contract Details
Ancillary Care Services
Facility name
Short Chiropractic
Provider ID
P000004758
NPI
1538197702
Tax ID
550771476
Effective Date
4/1/2012
Last Updated
10/21/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
99 Cracker Barrel Drive Suite 200
Barboursville, WV 25504
United States
County
Cabell
Phone
3047334616 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address