Provider Demographics
NPI:1003635301
Name:BAHBAH CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:BAHBAH CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAHBAH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-751-4220
Mailing Address - Street 1:2207 SWIFTWATER WAY
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-4606
Mailing Address - Country:US
Mailing Address - Phone:602-751-4220
Mailing Address - Fax:
Practice Address - Street 1:210 S GRAND AVE STE 109
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4260
Practice Address - Country:US
Practice Address - Phone:602-751-4220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAHBAH CHIROPRACTIC CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-04
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty