Provider Demographics
NPI:1245956952
Name:FAHMA HEALTH AND WELLNESS CENTER LLC
Entity type:Organization
Organization Name:FAHMA HEALTH AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OVNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEHIRETA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBADZIC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:720-936-0879
Mailing Address - Street 1:3801 SW HALL BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2049
Mailing Address - Country:US
Mailing Address - Phone:503-601-0056
Mailing Address - Fax:503-419-6068
Practice Address - Street 1:3801 SW HALL BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2049
Practice Address - Country:US
Practice Address - Phone:503-601-0056
Practice Address - Fax:503-419-6068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty