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Daniel
J
Hannan
DC
Contract Details
Facility name
Provider ID
P000005045
NPI
1669453874
Tax ID
421205848
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
2821 Hubbell Ave
Des Moines, IA 50317
United States
County
Polk
Phone
5152631313
(
Phone
)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
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Address