Provider Demographics
NPI:1376921270
Name:FADAHUNSI, AYODELE KOLAWOLE (DC)
Entity Type:Individual
Prefix:DR
First Name:AYODELE
Middle Name:KOLAWOLE
Last Name:FADAHUNSI
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 1:509 N HAMPTON RD
Mailing Address - Street 2:100A
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-4970
Mailing Address - Country:US
Mailing Address - Phone:469-297-6575
Mailing Address - Fax:
Practice Address - Street 1:509 N HAMPTON RD
Practice Address - Street 2:100A
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4970
Practice Address - Country:US
Practice Address - Phone:469-297-6575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12937111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor