Matthew    Nuesse    DC
Contract Details
Facility name
Provider ID
P000004765
NPI
1538349204
Tax ID
205795608
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
111 West Jackson Blvd Suite 1160
Chicago, IL 60604
United States
County
Cook
Phone
3125830061 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address