Provider Demographics
NPI:1417127523
Name:AISLIN M GEROW DC PA
Entity Type:Organization
Organization Name:AISLIN M GEROW DC PA
Other - Org Name:TROPHY CLUB CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AISLIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GEROW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-430-0000
Mailing Address - Street 1:2720 CHATSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7722
Mailing Address - Country:US
Mailing Address - Phone:817-471-7454
Mailing Address - Fax:817-571-9717
Practice Address - Street 1:501 TROPHY LAKE DR STE 322
Practice Address - Street 2:
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262-5239
Practice Address - Country:US
Practice Address - Phone:817-430-0000
Practice Address - Fax:817-490-5138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10573111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB113369Medicare UPIN
TXTXB113369Medicare PIN