Provider Demographics
NPI:1447227574
Name:BAILEY, JOHN ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 PRINCETON AVE N
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-1438
Mailing Address - Country:US
Mailing Address - Phone:509-662-0309
Mailing Address - Fax:509-664-8962
Practice Address - Street 1:1303 PRINCETON AVE N
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-1438
Practice Address - Country:US
Practice Address - Phone:509-662-0309
Practice Address - Fax:509-664-8962
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001388111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA16232OtherLABOR & INDUSTRIES
WABAIJ2814361348OtherPEMERA BLUE CROSS
WACH00001388OtherCHIROPRACTIC LICENSE
WA2039600Medicaid
35006437OtherRAILROAD MEDICARE
WACH00001388OtherCHIROPRACTIC LICENSE