Provider Demographics
NPI:1871631200
Name:BAILES, LISA ROBIN (DC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ROBIN
Last Name:BAILES
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:PO BOX 4036
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21094-4036
Mailing Address - Country:US
Mailing Address - Phone:410-252-7770
Mailing Address - Fax:410-252-7774
Practice Address - Street 1:54 SCOTT ADAM RD STE 104
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-3351
Practice Address - Country:US
Practice Address - Phone:410-252-7770
Practice Address - Fax:410-252-7774
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01507111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR1230001OtherBLUECROSS FEDERAL
MD103434OtherEHP
MD4304151OtherAETNA
MDR1230001OtherBLUECROSS BLUECHOICE
MD1005453OtherASHN
MD52664402OtherBLUECROSS BLUESHIELD
MD2135093OtherMDIPA/UNITED HEALTHCARE
MD39518OtherCOVENTRY
MD2135093OtherMDIPA/UNITED HEALTHCARE
MD403139Medicare UPIN