Contract Details
Ancillary Care Services
Facility name
Fort Lauderdale Chiropractic Center
Provider ID
P000005559
NPI
1891782769
Tax ID
650514412
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
200 Southeast 12th Street
Fort Lauderdale, FL 33316
United States
County
Broward
Phone
9544632404 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address