Randy    Klinedinst    DC
Contract Details
Facility name
Provider ID
P000005026
NPI
1659419331
Tax ID
371093733
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
103 South Main St
Canton, IL 61520
United States
County
Fulton
Phone
3096478030 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address