Martin    Jacobson    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000003683
NPI
1043284185
Tax ID
593058239
Effective Date
4/1/2012
Last Updated
10/2/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
1051 Port Malabar Boulevard Northeast Suite 2
Palm Bay, FL 32905
United States
County
Brevard
Phone
3217257003 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address