Contract Details
Ancillary Care Services
Facility name
Weston Chiropractic
Provider ID
P000004107
NPI
1245332840
Tax ID
273202670
Effective Date
9/27/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
1398 Southwest 160th Avenue Suite 102
Sunrise, FL 33326
United States
County
Broward
Phone
9543842925 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address