Provider Demographics
NPI:1134771389
Name:BAILEY, KEYSA (DC)
Entity type:Individual
Prefix:DR
First Name:KEYSA
Middle Name:
Last Name:BAILEY
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 1:3503 MARVYN PKWY LOT 185
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36804-6120
Mailing Address - Country:US
Mailing Address - Phone:334-559-4672
Mailing Address - Fax:
Practice Address - Street 1:1089 COLUMBIA DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-4728
Practice Address - Country:US
Practice Address - Phone:678-705-3404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010225111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor