Neal    Wieder    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005791
NPI
1992806392
Tax ID
591898224
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
2139 West State Road 434 Suite 102
Longwood, FL 32779
United States
County
Seminole
Phone
4076824454 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address