Contract Details
Facility name
Lake City Chiropractic PA
Provider ID
P000005413
NPI
1811179781
Tax ID
562314863
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
512 West Duval St
Lake City, FL 32055
United States
County
Columbia
Phone
3867523877 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address