MEDICARE: DR. TODD ROBERT CUSTER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	10274	TX

General Provider Information

NPI Number	:	1043245574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TODD ROBERT CUSTER D.C.

Provider Business Mailing Address
First Line	:	804 W MONTGOMERY ST
Second Line	:
City	:	WILLIS
State	:	TX
Zip	:	77378-8830
Country	:	US
Telephone Number	:	936-856-8908
Fax Number	:	936-856-8022

Provider Business Practice Location Address
First Line	:	804 W MONTGOMERY ST
Second Line	:
City	:	WILLIS
State	:	TX
Zip	:	77378-8830
Country	:	US
Telephone Number	:	936-856-8908
Fax Number	:	936-856-8022

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	01/14/2014

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