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 1:19115 FARM TO MARKET ROAD 2252
Mailing Address - Street 2:SUITE 8
Mailing Address - City:GARDEN RIDGE
Mailing Address - State:TX
Mailing Address - Zip Code:78266
Mailing Address - Country:US
Mailing Address - Phone:956-342-7189
Mailing Address - Fax:
Practice Address - Street 1:19115 FARM TO MARKET ROAD 2252
Practice Address - Street 2:SUITE 8
Practice Address - City:GARDEN RIDGE
Practice Address - State:TX
Practice Address - Zip Code:78266
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:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15922111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor