Gregory    Johnson    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005802
NPI
1073739678
Tax ID
455232731
Effective Date
8/23/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
363 North Sam Houston Parkway East Suite 1100
Houston, TX 77060
United States
County
Harris
Phone
2814052611 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address