Gregg    Moses    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005523
NPI
1881616142
Tax ID
650760094
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
1800 Forest Hill Boulevard Suite A8
West Palm Beach, FL 33406
United States
County
Palm Beach
Phone
5616419211 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address