Provider Demographics
NPI:1922482371
Name:BISIRIYU, OLUTOSIN (DC)
Entity Type:Individual
Prefix:DR
First Name:OLUTOSIN
Middle Name:
Last Name:BISIRIYU
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2418 HIGHWAY 121
Mailing Address - Street 2:2008
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-5158
Mailing Address - Country:US
Mailing Address - Phone:773-957-5910
Mailing Address - Fax:
Practice Address - Street 1:2008 E HEBRON PKWY
Practice Address - Street 2:130
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-1602
Practice Address - Country:US
Practice Address - Phone:972-428-3905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor