Kevan    Kruse    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005484
NPI
1861422677
Tax ID
271712623
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
641 West Lumsden Road
Brandon, FL 33511
United States
County
Hillsborough
Phone
8136545413 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address