Chad    Wersell    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004508
NPI
1427099514
Tax ID
742907091
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
15150 Nacogdoches Road Suite 185
San Antonio, TX 78247
United States
County
Bexar
Phone
2106556130 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address