Common Contracts

PARTICIPATING PROVIDER AGREEMENT

Agreement • December 10th, 2010 • Minnesota

• Contract Type
  Agreement
• Filed
  December 10th, 2010
• Jurisdiction
  Minnesota

The undersigned chiropractor, whose licensee(s) to practice chiropractic is(are) in good standing, and all license numbers are listed below, hereby agrees to all terms, conditions and provisions of the attached CHIROPRACTIC CARE OF MINNESOTA, INC. PARTICIPATING PROVIDER AGREEMENT. By checking the box below, the undersigned chiropractor elects to participate in the HealthPartners Worker’s Compensation Addendum to this Agreement. The undersigned chiropractor further agrees and understands that this agreement shall not be given effect until it has been countersigned by the appropriate officer of Chiropractic Care of Minnesota, Inc.

CHIROPRACTIC CARE OF MINNESOTA, INC. PARTICIPATING PROVIDER AGREEMENT

Agreement • December 10th, 2010 • Iowa

• Contract Type
  Agreement
• Filed
  December 10th, 2010
• Jurisdiction
  Iowa

standing, and all license numbers are listed below, hereby agrees to all terms, conditions and provisions of the attached CHIROPRACTIC CARE OF MINNESOTA, INC. PARTICIPATING PROVIDER AGREEMENT. By checking the box below, the undersigned chiropractor elects to participate in the HealthPartners Worker’s Compensation Addendum to this Agreement. The undersigned chiropractor further agrees and understands that this agreement shall not be given effect until it has been countersigned by the appropriate officer of Chiropractic Care of Minnesota, Inc.

CHIROPRACTIC CARE OF MINNESOTA, INC. PARTICIPATING PROVIDER AGREEMENT

Agreement • December 3rd, 2010 • Nebraska

• Contract Type
  Agreement
• Filed
  December 3rd, 2010
• Jurisdiction
  Nebraska

standing, and all license numbers are listed below, hereby agrees to all terms, conditions and provisions of the attached CHIROPRACTIC CARE OF MINNESOTA, INC. PARTICIPATING PROVIDER AGREEMENT. By checking the box below, the undersigned chiropractor elects to participate in the HealthPartners Worker’s Compensation Addendum to this Agreement. The undersigned chiropractor further agrees and understands that this agreement shall not be given effect until it has been countersigned by the appropriate officer of Chiropractic Care of Minnesota, Inc.