Contract Details
Ancillary Care Services
Facility name
Billingsley & Luckett Chiropractic Life Center
Provider ID
P000004115
NPI
1245426097
Tax ID
770620888
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
3289 Salem Road
Covington, GA 30016
United States
County
Newton
Phone
7707601396 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address