Thomas Aaron    Ford    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005224
NPI
1730245200
Tax ID
010788546
Effective Date
4/1/2012
Last Updated
9/27/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1304 North Main Street
La Fayette, GA 30728
United States
County
Walker
Phone
7066393333 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address