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Constantina
R
Boshell
DC
Contract Details
Facility name
Provider ID
P000000173
NPI
1013926815
Tax ID
680514866
Effective Date
10/1/2004
Last Updated
11/21/2011
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
84 Hwy 195 Suite A
Jasper, AL 35503
United States
County
Walker
Phone
2052219951
(
Phone
)
Billing Details
Address
Specialty Type
Chiropractic Medicine
Map
Address