Provider Demographics
NPI:1528581980
Name:AZZAM, ABDALLAH (DC)
Entity Type:Individual
Prefix:
First Name:ABDALLAH
Middle Name:
Last Name:AZZAM
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 1:7271 WURZBACH RD STE 133
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-3892
Mailing Address - Country:US
Mailing Address - Phone:210-255-3888
Mailing Address - Fax:210-255-3872
Practice Address - Street 1:7271 WURZBACH RD STE 133
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3892
Practice Address - Country:US
Practice Address - Phone:210-255-3888
Practice Address - Fax:210-255-3872
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor