Provider Demographics
NPI:1255987137
Name:BURAIMOH, OLUSEGUN A (DC)
Entity type:Individual
Prefix:
First Name:OLUSEGUN
Middle Name:A
Last Name:BURAIMOH
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 1:1247 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4432
Mailing Address - Country:US
Mailing Address - Phone:508-584-0068
Mailing Address - Fax:508-584-6573
Practice Address - Street 1:1247 BELMONT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4432
Practice Address - Country:US
Practice Address - Phone:508-584-0068
Practice Address - Fax:508-584-6573
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACHI3662111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty