Contract Details
Ancillary Care Services
Facility name
The Conklin Clinic
Provider ID
P000004476
NPI
1417078262
Tax ID
208361455
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
15055 East Freeway Suite C-10
Channelview, TX 77530
United States
County
Harris
Phone
2818620800 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address