John    Sipple    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000006147
Tax ID
270581795
Effective Date
4/1/2012
Last Updated
10/10/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
502 Richmond Road North
Berea, KY 40403
United States
County
Madison
Phone
8599864863 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address