Christopher    Stock    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005482
NPI
1851669253
Tax ID
352102197
Effective Date
4/1/2012
Last Updated
10/21/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
2129 Edsel Lane Northwest
Corydon, IN 47112
United States
County
Harrison
Phone
8127388020 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address