Healthcare Provider Details

I. General information

NPI: 1356350045
Provider Name (Legal Business Name): FREDA MARIE BAHAM D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 CHIMNEY ROCK RD SUITE X
HOUSTON TX
77081-2706
US

IV. Provider business mailing address

PO BOX 525
BELLAIRE TX
77402-0525
US

V. Phone/Fax

Practice location:
  • Phone: 713-661-7979
  • Fax: 713-661-7980
Mailing address:
  • Phone: 713-661-7979
  • Fax: 713-661-7980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number9345
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: