Healthcare Provider Details

I. General information

NPI: 1932282522
Provider Name (Legal Business Name): GREG D ZYGMONT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 SLAUGHTER LN W SUITE #470
AUSTIN TX
78749-6511
US

IV. Provider business mailing address

5900 SLAUGHTER LN W SUITE #470
AUSTIN TX
78749-6511
US

V. Phone/Fax

Practice location:
  • Phone: 512-288-5502
  • Fax: 512-288-6529
Mailing address:
  • Phone: 512-288-5502
  • Fax: 512-288-6529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8017
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: