Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 14360 | TX |
NPI | 1053943506 |
---|---|
Provider Name | Gordon Tyler Begley |
First Address | Austin, TX 78738-0022 |
Second Address | Austin, TX 78738-5551 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2020 |
Last Update Date | 12/02/2020 |