Provider Demographics
NPI:1851621478
Name:JEWETT, BAILEY T (DC)
Entity Type:Individual
Prefix:DR
First Name:BAILEY
Middle Name:T
Last Name:JEWETT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11180 WARNER AVE
Mailing Address - Street 2:STE 361
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7501
Mailing Address - Country:US
Mailing Address - Phone:714-444-0070
Mailing Address - Fax:714-444-0017
Practice Address - Street 1:11180 WARNER AVE
Practice Address - Street 2:STE 361
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7501
Practice Address - Country:US
Practice Address - Phone:714-444-0070
Practice Address - Fax:714-444-0017
Is Sole Proprietor?:No
Enumeration Date:2010-01-04
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24431111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor