Provider Demographics
NPI:1164641239
Name:BAKHTAR, HOMA (DC)
Entity Type:Individual
Prefix:DR
First Name:HOMA
Middle Name:
Last Name:BAKHTAR
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 1:1500 E KATELLA AVE STE G
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-5093
Mailing Address - Country:US
Mailing Address - Phone:714-639-7654
Mailing Address - Fax:714-639-8578
Practice Address - Street 1:1500 E KATELLA AVE STE G
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92876-5097
Practice Address - Country:US
Practice Address - Phone:714-639-7654
Practice Address - Fax:714-639-8578
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22279111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor