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General NPI Number Information
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NPI Number | 1548205933
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Entity Type | Individual
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Provider Name | GLORIA M BAESE DC
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Gender | Female
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 6913 S CANTON AVE 300
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City | TULSA
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State | OK
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Zip | 74136-3426
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Country | US
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Telephone | 918-664-5588
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Fax | 918-664-4394
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Provider Business Mailing Address
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Address Line | 4608 S HARVARD AVE STE C
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City | TULSA
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State | OK
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Zip | 74135-2913
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Country | US
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Telephone | 918-664-5588
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Fax | 918-664-4394
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2461
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License Number State | OK
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