Contract Details
Ancillary Care Services
Facility name
Wharton Chiropractic
Provider ID
P000004444
NPI
1396948626
Tax ID
742051593
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
806 North Fulton Street
Wharton, TX 77488
United States
County
Wharton
Phone
9795320261 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address