Provider Demographics
NPI:1093147514
Name:BAHAM LACOUR, JULIE (DC)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:BAHAM LACOUR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27999 OLD STH WALKER RD
Mailing Address - Street 2:STE B
Mailing Address - City:WALKER
Mailing Address - State:LA
Mailing Address - Zip Code:70785-6048
Mailing Address - Country:US
Mailing Address - Phone:225-271-4083
Mailing Address - Fax:225-271-4208
Practice Address - Street 1:4700 HARDY ST
Practice Address - Street 2:SUITE M
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1300
Practice Address - Country:US
Practice Address - Phone:601-261-5510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1714111N00000X
MS1211111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor