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Dirk
Yasko
DC
Contract Details
Eastern Chiropractic and Rehab
Facility name
Provider ID
P000001911
NPI
1801877840
Tax ID
631243293
Effective Date
12/15/2004
Last Updated
5/7/2013
Direct Contract
Yes
Status
Active
W9 Attachment
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
4735 Norrell Drive
Trussville, AL 35173
United States
County
Jefferson
Phone
2056550123
(
Phone
)
Billing Details
Address
Specialty Type
Chiropractic Medicine
Map
Address