Daniel    Velliquette    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005721
NPI
1962586685
Tax ID
364530044
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
971 Chestnut Hills Parkway
Fort Wayne, IN 46814
United States
County
Allen
Phone
2606256511 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address