Roger  L  Ingram    DC
Contract Details
Rainsville Chiropractic Medicine
Facility name
Provider ID
P000000822
NPI
1093746695
Tax ID
412058593
Effective Date
4/4/2005
Last Updated
6/10/2016
Direct Contract
Yes
Term Date
3/4/2014
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
460 Main Street West
Rainsville, AL 35986
United States
County
De Kalb
Phone
2566384228 (Phone)
Billing Details
Address
P.O. Box 423
Rainsville, AL 35986
Specialty Type
Chiropractic Medicine
Map
Address