Provider Demographics
NPI:1902036189
Name:BAILEY, MATTHEW SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:SCOTT
Last Name:BAILEY
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 1:1100 LIBERTY ST SE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4154
Mailing Address - Country:US
Mailing Address - Phone:503-689-1604
Mailing Address - Fax:503-689-1645
Practice Address - Street 1:1100 LIBERTY ST SE
Practice Address - Street 2:SUITE 2
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4154
Practice Address - Country:US
Practice Address - Phone:503-689-1604
Practice Address - Fax:503-689-1645
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3791111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR17287Medicare PIN