Provider Demographics
NPI:1871624296
Name:BAILEY, JASON ARNOLD (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:ARNOLD
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 1:224 SOUTH PARK CIR EAST
Mailing Address - Street 2:
Mailing Address - City:ST. AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086
Mailing Address - Country:US
Mailing Address - Phone:904-342-4941
Mailing Address - Fax:904-342-4937
Practice Address - Street 1:224 SOUTHPARK CIR E
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086
Practice Address - Country:US
Practice Address - Phone:904-342-4941
Practice Address - Fax:904-342-4937
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7429111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381217100Medicaid
FL55643AMedicare UPIN
FL381217100Medicaid