Provider Demographics
NPI:1477645364
Name:NEJAT-BAKHSH, FATTOLLAH (DC)
Entity Type:Individual
Prefix:DR
First Name:FATTOLLAH
Middle Name:
Last Name:NEJAT-BAKHSH
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 1:603 ISOM RD
Mailing Address - Street 2:STE # 103
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-4455
Mailing Address - Country:US
Mailing Address - Phone:210-340-0333
Mailing Address - Fax:210-340-0955
Practice Address - Street 1:603 ISOM RD
Practice Address - Street 2:STE # 103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4455
Practice Address - Country:US
Practice Address - Phone:210-340-0333
Practice Address - Fax:210-340-0955
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9120111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
7067472OtherAETNA
TX4370625OtherCIGNA
TX656439OtherACN
606413OtherBCBS
TX155508801Medicaid
TX656439OtherACN
TX155508801Medicaid