Clyde    Miller  Sr  DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004910
NPI
1598847485
Tax ID
269367876
Effective Date
4/1/2012
Last Updated
10/10/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
3701 Frederica Street
Owensboro, KY 42301
United States
County
Daviess
Phone
2706839551 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address