Provider Demographics
NPI:1902903149
Name:CRAIGHEAD, GARRY W (DC)
Entity Type:Individual
Prefix:DR
First Name:GARRY
Middle Name:W
Last Name:CRAIGHEAD
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 1:8500 SHOAL CREEK BLVD BLDG 2
Mailing Address - Street 2:STE E
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-7591
Mailing Address - Country:US
Mailing Address - Phone:512-323-6900
Mailing Address - Fax:512-323-6900
Practice Address - Street 1:8500 SHOAL CREEK BLVD BLDG 2
Practice Address - Street 2:STE E
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-7591
Practice Address - Country:US
Practice Address - Phone:512-323-6900
Practice Address - Fax:512-323-6900
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC6847111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU60757Medicare UPIN