MEDICARE: GERRY D. LANGSTON D.C., D.A.B.C.I.

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	:	1578655502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERRY D. LANGSTON D.C., D.A.B.C.I.

Provider Business Mailing 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

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/09/2007

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