Contract Details
Ancillary Care Services
Facility name
Warner Chiropractic
Provider ID
P000003703
NPI
1053309468
Tax ID
342030732
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
11470 Cleveland Avenue South
Fort Myers, FL 33907
United States
County
Lee
Phone
2394892225 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address