Lawrence    Benneth    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000003888
NPI
1134265648
Tax ID
611357655
Effective Date
4/1/2012
Last Updated
10/10/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
705 South Main Street
Hartford, KY 42347
United States
County
Ohio
Phone
2702989510 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address