John    Maltese    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004026
NPI
1215061155
Tax ID
582160094
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
900 Indian Trail Road Northwest
Lilburn, GA 30047
United States
County
Gwinnett
Phone
7703810491 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address