Provider Demographics
NPI:1972841310
Name:BAHAN, JOSEPH ROBERT (DC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ROBERT
Last Name:BAHAN
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 1:23 OBISPO
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-3171
Mailing Address - Country:US
Mailing Address - Phone:714-276-2300
Mailing Address - Fax:
Practice Address - Street 1:23 OBISPO
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-3171
Practice Address - Country:US
Practice Address - Phone:714-276-2300
Practice Address - Fax:714-276-2380
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20506111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor