Healthcare Provider Details

I. General information

NPI: 1255337937
Provider Name (Legal Business Name): KARA WARD MCGILLIVRAY DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4602 GRAND AVE STE 1000
DULUTH MN
55807-2712
US

IV. Provider business mailing address

2222 E 5TH ST
SUPERIOR WI
54880-3709
US

V. Phone/Fax

Practice location:
  • Phone: 218-336-3520
  • Fax: 218-624-6097
Mailing address:
  • Phone: 715-395-5393
  • Fax: 715-392-1935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3191
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3257
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: