Provider Demographics
NPI:1144284571
Name:BAILEY, MARK J (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:J
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:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:ESSEXVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48732-0070
Mailing Address - Country:US
Mailing Address - Phone:989-835-9250
Mailing Address - Fax:989-835-9251
Practice Address - Street 1:6021 EASTMAN AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2541
Practice Address - Country:US
Practice Address - Phone:989-835-9250
Practice Address - Fax:989-835-9251
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008522111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP2862001Medicare UPIN
MI0P28620Medicare ID - Type Unspecified