Contract Details
Ancillary Care Services
Facility name
Cloverleaf Chiropractic Clinic
Provider ID
P000003694
NPI
1043396542
Tax ID
650417452
Effective Date
4/1/2012
Last Updated
10/2/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
177 Northeast 167th Street
North Miami Beach, FL 33162
United States
County
Miami-Dade
Phone
3056518100 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address