MEDICARE: GENTRY A & B INC.

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	1809	OK

General Provider Information

NPI Number	:	1447463831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENTRY A & B INC.

Provider Business Mailing Address
First Line	:	4435 NW 36TH ST STE A
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-2704
Country	:	US
Telephone Number	:	405-942-5313
Fax Number	:	405-948-0167

Provider Business Practice Location Address
First Line	:	4435 NW 36TH ST STE A
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-2704
Country	:	US
Telephone Number	:	405-942-5313
Fax Number	:	405-948-0167

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WILLIAM BYRON GENTRY
Credential	:	DC
Telephone Number	:	405-942-5313

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	10/16/2008

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