Blake  A  Williams    DC
Contract Details
Facility name
Provider ID
P000004772
NPI
1538493077
Tax ID
271020711
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
1211 12th Ave Southeast Suite 102
Dyersville, IA 52040
United States
County
Dubuque
Phone
5638752738 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address