Contract Details
Ancillary Care Services
Facility name
West Bay Chiropractic Clinic
Provider ID
P000004408
NPI
1386862332
Tax ID
591439797
Effective Date
4/1/2012
Last Updated
10/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
2001 West Bay Drive
Largo, FL 33770
United States
County
Pinellas
Phone
7275845737 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address