Kenneth    Kitching    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004248
NPI
1316021272
Tax ID
582440265
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
110 Rushing Lane
Statesboro, GA 30458
United States
County
Bulloch
Phone
9126812225 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address