Provider Demographics
NPI:1619662046
Name:100 CHIRO BAYLESS, PLLC
Entity Type:Organization
Organization Name:100 CHIRO BAYLESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENNETT
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYLESS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-715-7983
Mailing Address - Street 1:1314 CALDERWOOD CT SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-3950
Mailing Address - Country:US
Mailing Address - Phone:615-715-7983
Mailing Address - Fax:
Practice Address - Street 1:15280 S JOG RD STE D
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-2169
Practice Address - Country:US
Practice Address - Phone:615-715-7983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty