Alan    Leichter    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005740
NPI
1972557361
Tax ID
382893358
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
1622 Mishawaka Avenue
South Bend, IN 46615
United States
County
St Joseph
Phone
5742881234 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address