Contract Details
Facility name
Texas Back Care Inc
Provider ID
P000005034
NPI
1659489870
Tax ID
752930070
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
2900 Hwy 121 Suite 120
Bedford, TX 76021
United States
County
Tarrant
Phone
8175451100 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address