Provider Demographics
NPI:1215798905
Name:BAHBAH, JACOB JACOB (DC)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:JACOB
Last Name:BAHBAH
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 1:2207 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:
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36846111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor