Mikhail    Yusim    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004763
NPI
1538276233
Tax ID
161738461
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
88.00
Location Details
Address
3100 Timmons Lane Suite 135
Houston, TX 77027
United States
County
Harris
Phone
7133555343 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address