Provider Demographics
NPI:1578246286
Name:WETZELL, BAILEY BERNICE (DC)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:BERNICE
Last Name:WETZELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 FREEPORT RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-8612
Mailing Address - Country:US
Mailing Address - Phone:815-590-5483
Mailing Address - Fax:
Practice Address - Street 1:3101 FREEPORT RD
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-8612
Practice Address - Country:US
Practice Address - Phone:815-590-5483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.014030111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor