John    Bernzott    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004147
NPI
1265507743
Tax ID
313580835
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
208 West 20th Street
Connersville, IN 47331
United States
County
Fayette
Phone
7658253521 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address