Timothy    Decubellis    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005002
NPI
1649293507
Tax ID
593027642
Effective Date
4/1/2012
Last Updated
10/2/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
8614 Little Road
New Port Richey, FL 34654
United States
County
Pasco
Phone
7278418488 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address