Contract Details
Ancillary Care Services
Facility name
Edelson Chiropractic Clinic
Provider ID
P000004864
NPI
1578622262
Tax ID
202031706
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
4250 Bay To Bay Boulevard
Tampa, FL 33629
United States
County
Hillsborough
Phone
8138318321 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address