Randall    Thomas    DC
Contract Details
Facility name
Provider ID
P000004739
NPI
1528142098
Tax ID
760336229
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
14441 Memorial Dr
Houston, TX 77079
United States
County
Harris
Phone
2815896324 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address