Juan  R  Cantu    DC
Contract Details
Facility name
Provider ID
P000006036
Tax ID
800265828
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
3450 38th Ave Suite 4
Moline, IL 61265
United States
County
Rock Island
Phone
3097642346 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address