Provider Demographics
NPI:1366505927
Name:BAILEY, LARRY G (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:G
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 1:107 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-2554
Mailing Address - Country:US
Mailing Address - Phone:615-355-1859
Mailing Address - Fax:615-355-0061
Practice Address - Street 1:107 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-2554
Practice Address - Country:US
Practice Address - Phone:615-355-1859
Practice Address - Fax:615-355-0061
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000000350111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3672837Medicare ID - Type Unspecified
TNT98281Medicare UPIN