Provider Demographics
NPI:1487219101
Name:ADIGUN, MORIAM (DC, MS, MED)
Entity Type:Individual
Prefix:DR
First Name:MORIAM
Middle Name:
Last Name:ADIGUN
Suffix:
Gender:F
Credentials:DC, MS, MED
Other - Prefix:DR
Other - First Name:SEUN
Other - Middle Name:
Other - Last Name:ADIGUN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC, MS, MED
Mailing Address - Street 1:PO BOX 980122
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-0122
Mailing Address - Country:US
Mailing Address - Phone:832-584-3834
Mailing Address - Fax:
Practice Address - Street 1:747 N SHEPHERD DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-1335
Practice Address - Country:US
Practice Address - Phone:713-320-2450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-08
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13818111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician