Brian    Hillary    DC
Contract Details
Facility name
Provider ID
P000005074
NPI
1679647325
Tax ID
800383903
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
25520 South Pheasant Ln Unit E
Channahon, IL 60410
United States
County
Will
Phone
8154675156 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address