Provider Demographics
NPI:1487991527
Name:BAILEY, ADAM JOHN (DOM)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:JOHN
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 CENTRAL AVE.
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712
Mailing Address - Country:US
Mailing Address - Phone:727-551-0857
Mailing Address - Fax:727-202-6896
Practice Address - Street 1:2520 CENTRAL AVE.
Practice Address - Street 2:
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712
Practice Address - Country:US
Practice Address - Phone:727-551-0857
Practice Address - Fax:727-202-6896
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3211171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist