Jeff    Rosner    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005019
NPI
1659329720
Tax ID
592459318
Effective Date
4/1/2012
Last Updated
10/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
822 Del Prado Boulevard South
Cape Coral, FL 33990
United States
County
Lee
Phone
2395743432 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address