MEDICARE: GLORIA M. BAESE, D.C. P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2461	OK

General Provider Information

NPI Number	:	1831306786
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLORIA M. BAESE, D.C. P.C.

Provider Business Mailing Address
First Line	:	6913 S CANTON AVE
Second Line	:	SUITE 300
City	:	TULSA
State	:	OK
Zip	:	74136-3432
Country	:	US
Telephone Number	:	918-664-5588
Fax Number	:

Provider Business Practice Location Address
First Line	:	6913 S CANTON AVE
Second Line	:	SUITE 300
City	:	TULSA
State	:	OK
Zip	:	74136-3432
Country	:	US
Telephone Number	:	918-664-5588
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GLORIA M BAESE
Credential	:	D.C.
Telephone Number	:	918-664-5588

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	08/22/2020

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