Provider Demographics
NPI:1184624710
Name:MACIVER, KELLY NOELLE (DC)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:NOELLE
Last Name:MACIVER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:NOELLE
Other - Last Name:HIPPERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:10700 SE 208TH ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-5545
Mailing Address - Country:US
Mailing Address - Phone:253-854-3185
Mailing Address - Fax:
Practice Address - Street 1:10700 SE 208TH ST
Practice Address - Street 2:SUITE 207
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-5545
Practice Address - Country:US
Practice Address - Phone:253-854-3185
Practice Address - Fax:253-852-9210
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034146111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA161332OtherLABOR AND INDUSTRIES
WA3948 HIOtherREGENCE BLUE SHIELD
WA8314270Medicaid
WA911088447OtherALTERNARE
WA40828OtherAMERICAN WHOLE HEALTH
WA8937182OtherCRIME VICTIMS COMPENSATIO
WA911088447OtherALTERNARE
WAAB15879Medicare ID - Type UnspecifiedGROUP NUMBER
WA40828OtherAMERICAN WHOLE HEALTH