Provider Demographics
NPI:1003648940
Name:OLORUNSOLA, MAYOWA (DC)
Entity type:Individual
Prefix:DR
First Name:MAYOWA
Middle Name:
Last Name:OLORUNSOLA
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 1:13611 SKINNER RD STE 120
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-2797
Mailing Address - Country:US
Mailing Address - Phone:803-399-0707
Mailing Address - Fax:
Practice Address - Street 1:13611 SKINNER RD STE 120
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-2797
Practice Address - Country:US
Practice Address - Phone:803-399-0707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty