Provider Demographics
NPI:1154525863
Name:ROGER D. BAILEY DC PLLC
Entity type:Organization
Organization Name:ROGER D. BAILEY DC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:931-424-3331
Mailing Address - Street 1:1119 E COLLEGE ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-4563
Mailing Address - Country:US
Mailing Address - Phone:931-424-3331
Mailing Address - Fax:931-363-9777
Practice Address - Street 1:1119 E COLLEGE ST
Practice Address - Street 2:SUITE 4
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-4563
Practice Address - Country:US
Practice Address - Phone:931-424-3331
Practice Address - Fax:931-363-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN325111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6143906OtherCIGNA HEALTHCARE
TN4053304OtherBCBS
TNDF6318OtherRAILROAD MEDICARE
TN3670619Medicare ID - Type UnspecifiedGROUP NUMBER
TNDF6318OtherRAILROAD MEDICARE