Provider Demographics
NPI:1205137759
Name:GISANRIN, ADEWALE (DC)
Entity type:Individual
Prefix:DR
First Name:ADEWALE
Middle Name:
Last Name:GISANRIN
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 1:6770 INDIAN CREEK DR APT 10D
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-5754
Mailing Address - Country:US
Mailing Address - Phone:616-889-9087
Mailing Address - Fax:
Practice Address - Street 1:235 W 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3713
Practice Address - Country:US
Practice Address - Phone:305-558-5432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-14
Last Update Date:2010-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10144111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor