Provider Demographics
NPI:1528046661
Name:BAILEY, KURT A (DC, NP-C)
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:A
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DC, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-5575
Mailing Address - Country:US
Mailing Address - Phone:208-799-3333
Mailing Address - Fax:208-799-3375
Practice Address - Street 1:3510 12TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-5575
Practice Address - Country:US
Practice Address - Phone:208-799-3333
Practice Address - Fax:208-799-3375
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-810111N00000X
WACH00003346111N00000X
IDNP-1087A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1673526Medicare ID - Type UnspecifiedMEDICARE ID