Eugene  A  Aiello    DC
Contract Details
Facility name
Provider ID
P000004776
NPI
1548208416
Tax ID
364218862
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
108 Third St Unit 2
Bloomingdale, IL 60108
United States
County
DuPage
Phone
6306270047 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address