Provider Demographics
NPI:1396830642
Name:GUTHRIE, ROBERT KELLY (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KELLY
Last Name:GUTHRIE
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 1:1508 N COACH HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-1212
Mailing Address - Country:US
Mailing Address - Phone:316-722-1292
Mailing Address - Fax:
Practice Address - Street 1:8404 W 13TH ST N
Practice Address - Street 2:#150
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-2978
Practice Address - Country:US
Practice Address - Phone:316-721-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4655111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060491OtherBLUE CROSS BLUE SHIELD
KS060491Medicare ID - Type Unspecified
KSU92736Medicare UPIN