Common Contracts
1 similar Membership and Participating Provider Agreement contracts
CHIROPRACTIC CARE OF MINNESOTA, INC. CERTIFICATE OF MEMBERSHIP AND PARTICIPATING PROVIDER AGREEMENTMembership and Participating Provider Agreement • March 24th, 2011
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 Workers’ 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.
