Provider Demographics
NPI:1417275405
Name:GUTHRIE, SHANNON LYN (DC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LYN
Last Name:GUTHRIE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 ASHEBROOKE SQ
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-4465
Mailing Address - Country:US
Mailing Address - Phone:304-692-7100
Mailing Address - Fax:
Practice Address - Street 1:526 ASHEBROOKE SQ
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-4465
Practice Address - Country:US
Practice Address - Phone:304-692-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV708111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor