Provider Demographics
NPI:1275179079
Name:OTUYELU, BABAFEMI (DC)
Entity Type:Individual
Prefix:
First Name:BABAFEMI
Middle Name:
Last Name:OTUYELU
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 1:2 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-2432
Mailing Address - Country:US
Mailing Address - Phone:201-360-2887
Mailing Address - Fax:201-721-6084
Practice Address - Street 1:2 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-2432
Practice Address - Country:US
Practice Address - Phone:201-360-2887
Practice Address - Fax:201-721-6084
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00762600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor