Provider Demographics
NPI:1376834382
Name:BAILEY HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:BAILEY HEALTH CENTER, LLC
Other - Org Name:HEALTH BUILDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TY
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-787-7555
Mailing Address - Street 1:125 MAIN ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRAVETTE
Mailing Address - State:AR
Mailing Address - Zip Code:72736-8753
Mailing Address - Country:US
Mailing Address - Phone:479-787-7555
Mailing Address - Fax:
Practice Address - Street 1:125 MAIN ST SE
Practice Address - Street 2:SUITE A
Practice Address - City:GRAVETTE
Practice Address - State:AR
Practice Address - Zip Code:72736-8753
Practice Address - Country:US
Practice Address - Phone:479-787-7555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR15,726111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5G896Medicare UPIN