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General NPI Number Information
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NPI Number | 1235498452
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Entity Type | Individual
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Provider Name | LUKUMONU AYODELE ADISA DC
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Gender | Male
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Dates
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Enumeration Date | 05/08/2012
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Last Update Date | 01/02/2019
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Provider Practice Location Address
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Address Line | 817 SILVER SPRING AVE STE 303
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City | SILVER SPRING
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State | MD
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Zip | 20910-4617
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Country | US
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Telephone | 301-755-1997
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Fax |
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Provider Business Mailing Address
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Address Line | 4805 W BRADDOCK RD APT 11
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City | ALEXANDRIA
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State | VA
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Zip | 22311-4805
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Country | US
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Telephone | 412-513-5514
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 0104557432
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | SO3689
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License Number State | MD
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