Contract Details
Facility name
Crest Hill Clinic Ltd
Provider ID
P000004377
NPI
1376548388
Tax ID
363458768
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
2430 Plainfield Rd
Crest Hill, IL 60403
United States
County
Will
Phone
8154392121 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address