Contract Details
Ancillary Care Services
Facility name
Westland Chiropractic Clinic
Provider ID
P000004885
NPI
1588829667
Tax ID
651122194
Effective Date
4/1/2012
Last Updated
10/9/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
8931 Conference Drive Suite 3
Fort Myers, FL 33919
United States
County
Lee
Phone
2394892225 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address