Healthcare Provider Details

I. General information

NPI: 1013829001
Provider Name (Legal Business Name): EMMANUEL AJAYI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22614 W 76TH TER
SHAWNEE KS
66227-2118
US

IV. Provider business mailing address

22614 W 76TH TER
SHAWNEE KS
66227-2118
US

V. Phone/Fax

Practice location:
  • Phone: 402-312-6296
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberO1-06431
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: