Provider Demographics
NPI:1356350045
Name:BAHAM, FREDA MARIE (DC)
Entity type:Individual
Prefix:MS
First Name:FREDA
Middle Name:MARIE
Last Name:BAHAM
Suffix:
Gender:F
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:PO BOX 525
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77402-0525
Mailing Address - Country:US
Mailing Address - Phone:713-661-7979
Mailing Address - Fax:713-661-7980
Practice Address - Street 1:5900 CHIMNEY ROCK RD
Practice Address - Street 2:SUITE X
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-2706
Practice Address - Country:US
Practice Address - Phone:713-661-7979
Practice Address - Fax:713-661-7980
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9345111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B9013Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER