Evan    Williams    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004837
NPI
1568575421
Tax ID
030357165
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
210 Lafayette Street
Pittsburg, TX 75686
United States
County
Camp
Phone
9038563665 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address