Provider Demographics
NPI:1609822667
Name:SEGHI, GARY (DC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:SEGHI
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 1:1613 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-5075
Mailing Address - Country:US
Mailing Address - Phone:512-478-1613
Mailing Address - Fax:512-478-1752
Practice Address - Street 1:1613 W 6TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-5075
Practice Address - Country:US
Practice Address - Phone:512-478-1613
Practice Address - Fax:512-478-1752
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC2668111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0011314-01Medicaid
TXDC2668OtherPIN
TX74-2286938OtherTAX
TX601053OtherBLUE CROSS BLUE SHIELD
TX74-2286938OtherTAX
TXT15822Medicare UPIN