Provider Demographics
NPI:1629590666
Name:BAILEY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:BAILEY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-634-2474
Mailing Address - Street 1:1450 EXECUTIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-9300
Mailing Address - Country:US
Mailing Address - Phone:812-634-2474
Mailing Address - Fax:812-634-6038
Practice Address - Street 1:1450 EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-9300
Practice Address - Country:US
Practice Address - Phone:812-634-2474
Practice Address - Fax:812-634-6038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-12
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002558A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty