Mark    Henary    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004230
NPI
1295973139
Tax ID
263950198
Effective Date
4/1/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
9525 Katy Freeway Suite 101
Houston, TX 77024
United States
County
Harris
Phone
7139326384 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address