Michael    Williams    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004463
NPI
1407876527
Tax ID
351919166
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
2129 Washington Avenue
Vincennes, IN 47591
United States
County
Knox
Phone
8128822240 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address