Todd    Elliott    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004647
NPI
1487625166
Tax ID
470852135
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
1940 South Wabash Street
Wabash, IN 46992
United States
County
Wabash
Phone
2605632222 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address