Provider Demographics
NPI:1851441976
Name:ODUWOLE, EMMANUEL ENITAN (DC)
Entity type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:ENITAN
Last Name:ODUWOLE
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 1:16430 VENTURA BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2141
Mailing Address - Country:US
Mailing Address - Phone:562-331-7642
Mailing Address - Fax:
Practice Address - Street 1:16430 VENTURA BLVD STE 207
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2141
Practice Address - Country:US
Practice Address - Phone:562-331-7642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29516111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractor