Provider Demographics
NPI:1255337937
Name:MCGILLIVRAY, KARA WARD (DC)
Entity type:Individual
Prefix:DR
First Name:KARA
Middle Name:WARD
Last Name:MCGILLIVRAY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-3709
Mailing Address - Country:US
Mailing Address - Phone:715-395-5393
Mailing Address - Fax:715-392-1935
Practice Address - Street 1:4602 GRAND AVE STE 1000
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55807-2712
Practice Address - Country:US
Practice Address - Phone:218-336-3520
Practice Address - Fax:218-624-6097
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3191111N00000X
MN3257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
4442057OtherAMERICAN CHIROPRACTIC NET
350055890OtherRAILROAD MEDICARE
MN565319300Medicaid
MN63G95MCOtherBCBS
MN63G95MCOtherBCBS
U61142Medicare UPIN