Lindsey    Day    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000003919
NPI
1154401487
Tax ID
352154854
Effective Date
4/1/2012
Last Updated
10/21/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1270 North Main Place
Mount Vernon, IN 47620
United States
County
Posey
Phone
8128386768 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address