David    Pine    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000003897
NPI
1144215062
Tax ID
592064994
Effective Date
4/1/2012
Last Updated
10/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
611 East Atlantic Boulevard
Pompano Beach, FL 33060
United States
County
Broward
Phone
9547827006 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address