Healthcare Provider Details

I. General information

NPI: 1831073394
Provider Name (Legal Business Name): BROC K BAILEY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3543 W MEMORIAL RD
OKLAHOMA CITY OK
73134-7015
US

IV. Provider business mailing address

11508 QUEENSBURY CT
YUKON OK
73099-8106
US

V. Phone/Fax

Practice location:
  • Phone: 405-440-3445
  • Fax:
Mailing address:
  • Phone: 405-478-1507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4680
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: