Provider Demographics
NPI:1316020373
Name:BAILEY, MARVIN JAY (DC)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:JAY
Last Name:BAILEY
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 1:308 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:IN
Mailing Address - Zip Code:46938-1113
Mailing Address - Country:US
Mailing Address - Phone:765-674-7231
Mailing Address - Fax:765-674-3640
Practice Address - Street 1:308 S MAIN ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:IN
Practice Address - Zip Code:46938-1113
Practice Address - Country:US
Practice Address - Phone:765-674-7231
Practice Address - Fax:765-674-3640
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000786A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN7085426OtherBLUE CROSS
IN7085426OtherBLUE CROSS
371130Medicare ID - Type Unspecified