Patrick Dale    Moore    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004658
NPI
1487725487
Tax ID
263489175
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
4320 South 7th Street
Terre Haute, IN 47802
United States
County
Vigo
Phone
8122997000 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address