David    Boczar    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004041
NPI
1215945597
Tax ID
200838468
Effective Date
4/1/2012
Last Updated
9/27/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
88.00
Location Details
Address
92 Village Circle
Brunswick, GA 31525
United States
County
Glynn
Phone
9122641806 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address