Provider Demographics
NPI:1942696661
Name:ABL CHIROPRACTIC LLC.
Entity Type:Organization
Organization Name:ABL CHIROPRACTIC LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:AYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-888-9122
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO009108111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty