Provider Demographics
NPI:1114507399
Name:AYLOR, AUSTIN WADE (DC)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:WADE
Last Name:AYLOR
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 1:3800 N MESA ST STE C1
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-1535
Mailing Address - Country:US
Mailing Address - Phone:915-838-1500
Mailing Address - Fax:915-838-1700
Practice Address - Street 1:3800 N MESA ST STE C1
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1535
Practice Address - Country:US
Practice Address - Phone:915-838-1500
Practice Address - Fax:915-838-1700
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14714111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor