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General NPI Number Information
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NPI Number | 1457566622
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Entity Type | Organization
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Legal Business Name | SCD BACK & JOINT CLINIC, LTD
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 10/17/2008
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Provider Practice Location Address
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Address Line | 200 EAST 24TH STREET SUITE B
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City | BRYAN
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State | TX
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Zip | 77803
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Country | US
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Telephone | 979-822-2225
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Fax | 979-822-8445
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Provider Business Mailing Address
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Address Line | 200 EAST 24TH STREET SUITE B
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City | BRYAN
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State | TX
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Zip | 77803
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Country | US
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Telephone | 979-822-2225
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Fax | 979-822-8445
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Authorized Official
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Title or Position | PRESIDENT OF GENERAL PARTNER
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Name | DR. DAVID N BAILEY
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Credential | DC
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Telephone | 979-822-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4061
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License Number State | TX
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