Dale    Beauvais    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000003895
NPI
1144203183
Tax ID
352070634
Effective Date
4/1/2012
Last Updated
10/21/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
88.00
Location Details
Address
2600 Roosevelt Road
Valparaiso, IN 46383
United States
County
Porter
Phone
2194655015 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address