Provider Demographics
NPI:1033757927
Name:BAILOR, SHELBI (LAC)
Entity Type:Individual
Prefix:
First Name:SHELBI
Middle Name:
Last Name:BAILOR
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1474 W CATALPA AVE # 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1212
Mailing Address - Country:US
Mailing Address - Phone:773-793-7392
Mailing Address - Fax:
Practice Address - Street 1:5646 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-4110
Practice Address - Country:US
Practice Address - Phone:773-793-7392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.000788171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist