Provider Demographics
NPI:1235498452
Name:ADISA, LUKUMONU AYODELE (DC)
Entity Type:Individual
Prefix:DR
First Name:LUKUMONU
Middle Name:AYODELE
Last Name:ADISA
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 1:4805 W BRADDOCK RD APT 11
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-4805
Mailing Address - Country:US
Mailing Address - Phone:412-513-5514
Mailing Address - Fax:
Practice Address - Street 1:817 SILVER SPRING AVE STE 303
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4617
Practice Address - Country:US
Practice Address - Phone:301-755-1997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557432111N00000X
MDSO3689111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor