Provider Demographics
NPI:1811020423
Name:GUENTHER, FREDERICK (DC)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:
Last Name:GUENTHER
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 1:127 E AUSTIN BLVD
Mailing Address - Street 2:STE D
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-3376
Mailing Address - Country:US
Mailing Address - Phone:417-549-9700
Mailing Address - Fax:
Practice Address - Street 1:127 E AUSTIN BLVD
Practice Address - Street 2:STE D
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-3376
Practice Address - Country:US
Practice Address - Phone:417-549-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000153089111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2000153089OtherMO STATE LICENSE NUMBER
MO2000153089OtherMO STATE LICENSE NUMBER
MO000A568Medicare UPIN