Provider Demographics
NPI:1831306786
Name:GLORIA M. BAESE, D.C. P.C.
Entity Type:Organization
Organization Name:GLORIA M. BAESE, D.C. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAESE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-664-5588
Mailing Address - Street 1:6913 S CANTON AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3432
Mailing Address - Country:US
Mailing Address - Phone:918-664-5588
Mailing Address - Fax:
Practice Address - Street 1:6913 S CANTON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3432
Practice Address - Country:US
Practice Address - Phone:918-664-5588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2461111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKUO4482Medicare UPIN