Bradley    Weiss    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005664
NPI
1942251970
Tax ID
592841625
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
11924 West Forest Hill Boulevard
Wellington, FL 33414
United States
County
Palm Beach
Phone
5617536077 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address