Provider Demographics
NPI:1053477026
Name:BAILEY, JERRY LEE II (DC)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:LEE
Last Name:BAILEY
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:520 E COEUR DALENE AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2873
Mailing Address - Country:US
Mailing Address - Phone:208-664-1644
Mailing Address - Fax:208-667-5568
Practice Address - Street 1:520 E COEUR DALENE AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2873
Practice Address - Country:US
Practice Address - Phone:208-664-1644
Practice Address - Fax:208-667-5568
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-932111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor