Thomas    McKeen  Jr  DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004133
NPI
1255497046
Tax ID
592273066
Effective Date
4/1/2012
Last Updated
10/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
2433 State Road 60 East
Lake Wales, FL 33898
United States
County
Polk
Phone
8636762717 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address