Kevin    Goyke    DC
Contract Details
Facility name
Provider ID
P000004778
NPI
1548226194
Tax ID
364137101
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
1301 South Route 59 Suite 109
Naperville, IL 60564
United States
County
Will
Phone
6308988900 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address