MEDICARE: LANGSTON CHIROPRACTIC CLINIC ,PC

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	111NI0900X	Internist Chiropractor	2112	OK

General Provider Information

NPI Number	:	1003050949
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANGSTON CHIROPRACTIC CLINIC ,PC

Provider Business Mailing Address
First Line	:	4503 SOUTH HARVARD
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-2905
Country	:	US
Telephone Number	:	918-747-5555
Fax Number	:	918-747-1028

Provider Business Practice Location Address
First Line	:	4503 S HARVARD AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-2905
Country	:	US
Telephone Number	:	918-747-5555
Fax Number	:	918-747-1028

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	MR. GERRY D LANGSTON
Credential	:	DC
Telephone Number	:	918-747-5555

Provider Enumeration Date	:	04/22/2009
Last Update Date	:	04/22/2009

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