Kyle    Studley    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004903
NPI
1598807331
Tax ID
201046617
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
45 Bryan Avenue
Labelle, FL 33935
United States
County
Hendry
Phone
8636753427 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address