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NPI Code Detail

MEDICARE: WILLIS SPINE & REHABILITATION

MEDICARE: WILLIS SPINE & REHABILITATION
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
1111N00000XChiropractor10274TX

General Provider Information

NPI Number : 1316215718
Entity Type Code : Organization
Provider Name (Legal Business Name) : WILLIS SPINE & REHABILITATION
Provider Business Mailing Address
First Line : 804 W MONTGOMERY ST
Second Line : SUITE A
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 : SUITE A
City : WILLIS
State : TX
Zip : 77378-8830
Country : US
Telephone Number : 936-856-8908
Fax Number : 936-856-8022
Authorized Official
Title or Position : OWNER/DOCTOR
Name : TODD R CUSTER
Credential : D.C., A.T.C.
Telephone Number : 936-856-8908
Provider Enumeration Date : 12/13/2011
Last Update Date : 04/29/2013

Similar Medicare Providers

1043245574 — DR. TODD ROBERT CUSTER D.C.
Practice Location Address:
804 W MONTGOMERY ST
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1841762556 — CONROE WILLIS FAMILY MEDICINE PLLC
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1023677382 — KELLI CRISP RN
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1851942445 — MR. TROY SCOTT FERGUSON PTA
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804 W MONTGOMERY ST
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Practice Location Address:
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1548073661 — DR. YANELLY HINOJOSA DC
Practice Location Address:
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Directions to “WILLIS SPINE & REHABILITATION ” Practice Location

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