Healthcare Provider Details

I. General information

NPI: 1184624710
Provider Name (Legal Business Name): KELLY NOELLE MACIVER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY NOELLE HIPPERT D.C.

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 SE 208TH ST SUITE 207
KENT WA
98031-5545
US

IV. Provider business mailing address

10700 SE 208TH ST SUITE 207
KENT WA
98031-5545
US

V. Phone/Fax

Practice location:
  • Phone: 253-854-3185
  • Fax: 253-852-9210
Mailing address:
  • Phone: 253-854-3185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00034146
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: