Contract Details
Ancillary Care Services
Facility name
Southern Chiropractic Life Center
Provider ID
P000005186
NPI
1710952254
Tax ID
650223761
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
10345 Southern Boulevard
Royal Palm Beach, FL 33411
United States
County
Palm Beach
Phone
5617906388 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address