Provider Demographics
NPI:1821165531
Name:BUSIN, GERALD (DC)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
Last Name:BUSIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 E 51ST ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-3628
Mailing Address - Country:US
Mailing Address - Phone:918-622-7300
Mailing Address - Fax:918-749-3595
Practice Address - Street 1:4100 E 51ST ST
Practice Address - Street 2:SUITE 100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-3628
Practice Address - Country:US
Practice Address - Phone:918-622-7300
Practice Address - Fax:918-749-3595
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3052111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5509072Medicare UPIN