Contract Details
Ancillary Care Services
Facility name
Grasso Chiropractic
Provider ID
P000005283
NPI
1760479463
Tax ID
650653959
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
335 West Oak Street
Kissimmee, FL 34741
United States
County
Osceola
Phone
4078701959 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address