Thomas    Maguire    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004487
NPI
1417919937
Tax ID
592751201
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
2825 East 4th Avenue
Hialeah, FL 33013
United States
County
Miami-Dade
Phone
3056930033 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address