Provider Demographics
NPI:1588849160
Name:BAILEY CHIROPRACTIC LIFE CENTER INC.
Entity Type:Organization
Organization Name:BAILEY CHIROPRACTIC LIFE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ARNOLD
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-342-4941
Mailing Address - Street 1:224 SOUTH PARK CIR EAST
Mailing Address - Street 2:
Mailing Address - City:ST. AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086
Mailing Address - Country:US
Mailing Address - Phone:904-342-4941
Mailing Address - Fax:904-342-4937
Practice Address - Street 1:14867 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-7928
Practice Address - Country:US
Practice Address - Phone:305-971-0302
Practice Address - Fax:305-971-8222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7429111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6070Medicare UPIN