Provider Demographics
NPI:1801661301
Name:AYALA, JORGE DANIEL
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:DANIEL
Last Name:AYALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6103 BALCONY LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75241-5060
Mailing Address - Country:US
Mailing Address - Phone:956-342-7189
Mailing Address - Fax:
Practice Address - Street 1:6103 BALCONY LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75241-5060
Practice Address - Country:US
Practice Address - Phone:956-342-7189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-15
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15922111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor