Healthcare Provider Details

I. General information

NPI: 1396830642
Provider Name (Legal Business Name): ROBERT KELLY GUTHRIE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8404 W 13TH ST N #150
WICHITA KS
67212-2978
US

IV. Provider business mailing address

1508 N COACH HOUSE RD
WICHITA KS
67235-1212
US

V. Phone/Fax

Practice location:
  • Phone: 316-721-3400
  • Fax:
Mailing address:
  • Phone: 316-722-1292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number4655
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: