Provider Demographics
NPI:1881622553
Name:BAILEY, RICHARD JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOSEPH
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 1:7 HOLLIS DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-1731
Mailing Address - Country:US
Mailing Address - Phone:203-775-1644
Mailing Address - Fax:203-775-0782
Practice Address - Street 1:304 FEDERAL RD
Practice Address - Street 2:SUITE 109
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2418
Practice Address - Country:US
Practice Address - Phone:203-775-5555
Practice Address - Fax:203-775-0782
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000252111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC01332Medicare ID - Type Unspecified
T98368Medicare UPIN
CTT98368Medicare UPIN