Provider Demographics
NPI:1710182522
Name:ZYGMONT CHIROPRACTIC CENTER, P.C.
Entity Type:Organization
Organization Name:ZYGMONT CHIROPRACTIC CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:COLETTE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:ZYGMONT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-442-7400
Mailing Address - Street 1:4036 S LAMAR BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7992
Mailing Address - Country:US
Mailing Address - Phone:512-442-7400
Mailing Address - Fax:512-442-7408
Practice Address - Street 1:4006 S LAMAR BLVD STE 650
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7993
Practice Address - Country:US
Practice Address - Phone:512-442-7400
Practice Address - Fax:512-442-7405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109648901Medicaid
TX4624OtherLICENSE NUMBER
TX4624OtherLICENSE NUMBER