Provider Demographics
NPI:1467843201
Name:AYLOR, MARK OWEN (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:OWEN
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 1:1388 N CROSSING DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3571
Mailing Address - Country:US
Mailing Address - Phone:303-888-9122
Mailing Address - Fax:
Practice Address - Street 1:1388 N CROSSING DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-3571
Practice Address - Country:US
Practice Address - Phone:303-888-9122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO009108111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor