Contract Details
Ancillary Care Services
Facility name
Lifestyle Resumption
Provider ID
P000005710
NPI
1962444653
Tax ID
371437152
Effective Date
4/1/2012
Last Updated
10/10/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
2182 Dixie Highway
Fort Mitchell, KY 41017
United States
County
Kenton
Phone
8593446001 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address