Healthcare Provider Details

I. General information

NPI: 1366512303
Provider Name (Legal Business Name): JARED LEE BAILEY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 05/01/2020
Certification Date: 05/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CEDAR VALLEY DR STE 2
CEDAR BLUFF VA
24609-9247
US

IV. Provider business mailing address

1100 CEDAR VALLEY DR STE 2
CEDAR BLUFF VA
24609-9247
US

V. Phone/Fax

Practice location:
  • Phone: 276-964-9960
  • Fax: 276-964-9964
Mailing address:
  • Phone: 276-964-9960
  • Fax: 276-964-9964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104556496
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: