Provider Demographics
NPI:1053943506
Name:BEGLEY, GORDON TYLER (DC)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:TYLER
Last Name:BEGLEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3544 RANCH ROAD 620 S APT 2201
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-0022
Mailing Address - Country:US
Mailing Address - Phone:469-243-4580
Mailing Address - Fax:
Practice Address - Street 1:11614 BEE CAVES RD STE 110
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-5551
Practice Address - Country:US
Practice Address - Phone:512-263-9961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14360111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician