Contract Details
Ancillary Care Services
Facility name
Family Wellness Center Kaurich Chiropractic
Provider ID
P000004213
NPI
1295768695
Tax ID
352047355
Effective Date
4/1/2012
Last Updated
10/21/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
3511 Lincoln Way West
South Bend, IN 46628
United States
County
St Joseph
Phone
5742822828 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address