Nicole    Miller    DC
Contract Details
Facility name
Provider ID
P000004877
NPI
1588693758
Tax ID
753096415
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
508 West Central Ave
Estherville, IA 51334
United States
County
Emmet
Phone
7123627715 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address