Healthcare Provider Details

I. General information

NPI: 1649479627
Provider Name (Legal Business Name): GUTHRIE CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E BROADWAY ST
SPIRO OK
74959-3041
US

IV. Provider business mailing address

2000 E BROADWAY ST
SPIRO OK
74959-3041
US

V. Phone/Fax

Practice location:
  • Phone: 918-962-2439
  • Fax: 918-967-8847
Mailing address:
  • Phone: 918-962-2439
  • Fax: 918-967-8847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2510
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0100325
License Number StateOK

VIII. Authorized Official

Name: DR. J BRETT GUTHRIE
Title or Position: PHYSICIAN
Credential: DC, APRN
Phone: 918-967-4697