L Bert    Williams    DC
Contract Details
Facility name
Provider ID
P000004259
NPI
1316930514
Tax ID
760063396
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
3960 FM 1960 West
Houston, TX 77068
United States
County
Harris
Phone
2814406355 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address