Contract Details
Ancillary Care Services
Facility name
Powerline Chiropractic
Provider ID
P000004985
NPI
1639218993
Tax ID
650782500
Effective Date
4/1/2012
Last Updated
10/2/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
4384 Northwest 31st Avenue
Oakland Park, FL 33309
United States
County
Broward
Phone
9544861377 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address