Provider Demographics
NPI:1912097361
Name:MCKELLAR, LORIANN (DC)
Entity Type:Individual
Prefix:DR
First Name:LORIANN
Middle Name:
Last Name:MCKELLAR
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 1:12416 NW 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-2225
Mailing Address - Country:US
Mailing Address - Phone:360-574-9440
Mailing Address - Fax:360-574-9288
Practice Address - Street 1:12416 NW 36TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-2225
Practice Address - Country:US
Practice Address - Phone:360-574-9440
Practice Address - Fax:360-574-9288
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034673111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0225697OtherL&I PAN
WA703832OtherACN PROVIDER ID
WA9478466OtherMULTIPLAN (PHCS) ID
WA8863691OtherMEDICARE GROUP PIN
WA885839001OtherREGENCE BC/BS OR
WA8863692Medicare PIN
WA0225697OtherL&I PAN