Individual
DR. KELLY NOELLE MACIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
10700 SE 208TH ST, SUITE 207, KENT, WA 98031-5545
(253) 854-3185
(253) 852-9210
Mailing address
10700 SE 208TH ST, SUITE 207, KENT, WA 98031-5545
(253) 854-3185
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CH00034146
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
161332
LABOR AND INDUSTRIES
WA
01
—
3948 HI
REGENCE BLUE SHIELD
WA
01
—
40828
AMERICAN WHOLE HEALTH
WA
05
—
8314270
—
WA
01
—
8937182
CRIME VICTIMS COMPENSATIO
WA
01
—
911088447
ALTERNARE
WA
Enumeration date
07/26/2005
Last updated
02/09/2012
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