Carol    Learned    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005651
NPI
1932262888
Tax ID
800487889
Effective Date
4/1/2012
Last Updated
10/9/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
147 East Granada Boulevard
Ormond Beach, FL 32176
United States
County
Volusia
Phone
3862655968 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address