Traci    Nelson    DC
Contract Details
Facility name
Provider ID
P000004627
NPI
1477566404
Tax ID
731689454
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
2377 Cumberland Square Dr
Bettendorf, IA 52722
United States
County
Scott
Phone
5633599541 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address