Provider Demographics
NPI:1083653448
Name:ADETOLA, ESTHER OLAYINKA (DC)
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:OLAYINKA
Last Name:ADETOLA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:ESTHER
Other - Middle Name:O
Other - Last Name:ORIOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 S 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-3958
Mailing Address - Country:US
Mailing Address - Phone:715-848-2526
Mailing Address - Fax:
Practice Address - Street 1:2230 W TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1545
Practice Address - Country:US
Practice Address - Phone:309-691-6750
Practice Address - Fax:309-691-6740
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3972-012111N00000X
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209275OtherMEDICARE GROUP
WI38948600Medicaid
ILP00352328OtherRAILROAD MEDICARE
CK6783OtherRAILROAD MEDICARE GROUP
CK6783OtherRAILROAD MEDICARE GROUP
WIU98149Medicare UPIN