Provider Demographics
NPI:1669484077
Name:GUTHRIE, WADE GILBERT (DC, PC)
Entity Type:Individual
Prefix:DR
First Name:WADE
Middle Name:GILBERT
Last Name:GUTHRIE
Suffix:
Gender:M
Credentials:DC, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3005
Mailing Address - Country:US
Mailing Address - Phone:541-636-3358
Mailing Address - Fax:541-636-3098
Practice Address - Street 1:295 W BROADWAY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3005
Practice Address - Country:US
Practice Address - Phone:541-636-3358
Practice Address - Fax:541-636-3098
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2014-10-08
Deactivation Date:2014-02-05
Deactivation Code:
Reactivation Date:2014-08-29
Provider Licenses
StateLicense IDTaxonomies
OR2289111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORT82349Medicare UPIN
OR0000QGFSVMedicare ID - Type Unspecified