Contract Details
Ancillary Care Services
Facility name
Madisonville Chiropractic Clinic
Provider ID
P000004436
NPI
1396880951
Tax ID
570739233
Effective Date
4/1/2012
Last Updated
9/26/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
3912 Highway 411
Madisonville, TN 37354
United States
County
Monroe
Phone
4234424153 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address