Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 4655 | KS |
NPI | 1396830642 |
---|---|
Provider Name | Dr. Robert Kelly Guthrie |
First Address | Wichita, KS 67235-1212 |
Second Address | Wichita, KS 67212-2978 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
060491 | BLUE CROSS BLUE SHIELD (01) | KS |
U92736 | (02) | KS |