Provider Demographics
NPI:1750945887
Name:ADEWOLE, ADEKUNLE SEGUN
Entity type:Individual
Prefix:
First Name:ADEKUNLE
Middle Name:SEGUN
Last Name:ADEWOLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1849 PEARLAND PKWY STE 107
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-5343
Mailing Address - Country:US
Mailing Address - Phone:281-412-9642
Mailing Address - Fax:
Practice Address - Street 1:1849 PEARLAND PKWY STE 107
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-5343
Practice Address - Country:US
Practice Address - Phone:281-412-9642
Practice Address - Fax:832-327-5121
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13322111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor