Provider Demographics
NPI:1861500266
Name:BAILEY-SHAW, KIMBERLY JOY (DC)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:JOY
Last Name:BAILEY-SHAW
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:PO BOX 8120
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:ME
Mailing Address - Zip Code:04901-8120
Mailing Address - Country:US
Mailing Address - Phone:207-873-5161
Mailing Address - Fax:207-873-5163
Practice Address - Street 1:138 HALIFAX ST
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:ME
Practice Address - Zip Code:04901
Practice Address - Country:US
Practice Address - Phone:207-873-5161
Practice Address - Fax:207-873-5163
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME770111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
B0244OtherANTHEM
M66170OtherHEALTHSURCE
015552OtherBCBS
ME0048OtherHARVARD PILGRIM
350034518OtherRR M'CARE
B0244OtherANTHEM
M66170OtherHEALTHSURCE