John    Brown    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000003731
NPI
1063487254
Tax ID
593534304
Effective Date
4/1/2012
Last Updated
10/2/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
2410 Saint Andrews Boulevard
Panama City, FL 32405
United States
County
Bay
Phone
8507693777 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address