Steven    Mercante    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004662
NPI
1487779625
Tax ID
582314985
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
6315 Spalding Drive Suite B
Norcross, GA 30092
United States
County
Gwinnett
Phone
7704169995 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address