Provider Demographics
NPI:1447463831
Name:GENTRY A & B INC.
Entity type:Organization
Organization Name:GENTRY A & B INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BYRON
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-942-5313
Mailing Address - Street 1:4435 NW 36TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2704
Mailing Address - Country:US
Mailing Address - Phone:405-942-5313
Mailing Address - Fax:405-948-0167
Practice Address - Street 1:4435 NW 36TH ST STE A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2704
Practice Address - Country:US
Practice Address - Phone:405-942-5313
Practice Address - Fax:405-948-0167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1809111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKO0609Medicare ID - Type UnspecifiedEDI PROVIDER ID
OKT75165Medicare UPIN
OKQDBWWMedicare ID - Type UnspecifiedMEDICARE