Provider Demographics
NPI:1215697503
Name:OYENIYA, SAMUEL OYEYEMI (DC)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:OYEYEMI
Last Name:OYENIYA
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 1:6728 PARK VISTA BLVD APT 303
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76137-4771
Mailing Address - Country:US
Mailing Address - Phone:551-240-8028
Mailing Address - Fax:
Practice Address - Street 1:400 S ZANG BLVD STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-6638
Practice Address - Country:US
Practice Address - Phone:972-392-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14967111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty