Jason    Ledford    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004510
NPI
1427113182
Tax ID
582525107
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
374 South Piedmont Street
Calhoun, GA 30701
United States
County
Gordon
Phone
7066029696 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address