Chad    Henderson    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004245
NPI
1306875554
Tax ID
611386605
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
1056 South Highway 27
Somerset, KY 42501
United States
County
Pulaski
Phone
6066796385 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address