Jason  J  Villalobos    DC
Contract Details
Facility name
Provider ID
P000005669
NPI
1942274238
Tax ID
205234445
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
102 West 2nd Ave
Indianola, IA 50125
United States
County
Warren
Phone
5159622166 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address