Joseph    Fields    DC
Contract Details
Facility name
Provider ID
P000006069
Tax ID
262947733
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
2210 Camden Ct
Oak Brook, IL 60523
United States
County
DuPage
Phone
8592730310 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address