Korey    Zwiefel    DC
Contract Details
Facility name
Provider ID
P000003814
NPI
1093990285
Tax ID
421506570
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
401 South 15th St
Clear Lake, IA 50428
United States
County
Cerro Gordo
Phone
6413573393 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address