Provider Demographics
NPI:1477831790
Name:AWOBUSUYI, OLUWASEUN T (DC)
Entity Type:Individual
Prefix:DR
First Name:OLUWASEUN
Middle Name:T
Last Name:AWOBUSUYI
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 1:2415 S BABCOCK ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-5369
Mailing Address - Country:US
Mailing Address - Phone:321-409-0021
Mailing Address - Fax:321-409-0027
Practice Address - Street 1:2415 S BABCOCK ST
Practice Address - Street 2:SUITE C
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5369
Practice Address - Country:US
Practice Address - Phone:321-409-0021
Practice Address - Fax:321-409-0027
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10378111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor