Provider Demographics
NPI:1952977381
Name:BLACK, BAILEY (DC)
Entity Type:Individual
Prefix:DR
First Name:BAILEY
Middle Name:
Last Name:BLACK
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 1:3354 SUMMERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-6534
Mailing Address - Country:US
Mailing Address - Phone:817-422-4493
Mailing Address - Fax:
Practice Address - Street 1:1903 CENTRAL DR STE 304
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5813
Practice Address - Country:US
Practice Address - Phone:972-556-5667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14675111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor