William    Misenheimer    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000006106
Tax ID
351825994
Effective Date
4/1/2012
Last Updated
10/21/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
3778 Union Street
Lafayette, IN 47905
United States
County
Tippecanoe
Phone
7654481674 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address