Mark  J  Davis    DC
Contract Details
Facility name
Provider ID
P000004876
NPI
1588668388
Tax ID
760387780
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
940 Gemini St
Houston, TX 77058
United States
County
Harris
Phone
2814861675 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address