Healthcare Provider Details

I. General information

NPI: 1649266305
Provider Name (Legal Business Name): ERIC SHAWN BAILEY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 MAIN ST SE SUITE A
GRAVETTE AR
72736-8753
US

IV. Provider business mailing address

125 MAIN ST SE SUITE A
GRAVETTE AR
72736-8753
US

V. Phone/Fax

Practice location:
  • Phone: 479-787-7555
  • Fax: 479-787-7444
Mailing address:
  • Phone: 479-787-7555
  • Fax: 479-787-7444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1380
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: