Provider Demographics
NPI:1548389596
Name:GUTHRIE, KIMBERLY I
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:GUTHRIE
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 KRUSE WAY PL
Mailing Address - Street 2:BLDG 2 SUITE 245
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035
Mailing Address - Country:US
Mailing Address - Phone:503-675-8747
Mailing Address - Fax:503-699-9136
Practice Address - Street 1:4000 KRUSE WAY PL
Practice Address - Street 2:BLDG 2 SUITE 245
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035
Practice Address - Country:US
Practice Address - Phone:503-675-8747
Practice Address - Fax:503-699-9136
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273093111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor