Provider Demographics
NPI:1184927568
Name:CARROLL, BAILEY RUSSELL (DC)
Entity type:Individual
Prefix:DR
First Name:BAILEY
Middle Name:RUSSELL
Last Name:CARROLL
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 1:100 PINE BROOK DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35633-1137
Mailing Address - Country:US
Mailing Address - Phone:256-284-7179
Mailing Address - Fax:256-284-7187
Practice Address - Street 1:100 PINE BROOK DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35633-1137
Practice Address - Country:US
Practice Address - Phone:256-284-7179
Practice Address - Fax:256-284-7187
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2464111N00000X
AL2320111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z18027OtherVIVA HEALTH
AL511-12119OtherBCBS