MEDICARE: DR. KELLY NOELLE MACIVER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH00034146	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	161332	OTHER	WA	LABOR AND INDUSTRIES
2	3948 HI	OTHER	WA	REGENCE BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	911088447	OTHER	WA	ALTERNARE
5	40828	OTHER	WA	AMERICAN WHOLE HEALTH
6	8937182	OTHER	WA	CRIME VICTIMS COMPENSATIO

General Provider Information

NPI Number	:	1184624710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY NOELLE MACIVER D.C.

Provider Business Mailing Address
First Line	:	10700 SE 208TH ST
Second Line	:	SUITE 207
City	:	KENT
State	:	WA
Zip	:	98031-5545
Country	:	US
Telephone Number	:	253-854-3185
Fax Number	:

Provider Business Practice Location Address
First Line	:	10700 SE 208TH ST
Second Line	:	SUITE 207
City	:	KENT
State	:	WA
Zip	:	98031-5545
Country	:	US
Telephone Number	:	253-854-3185
Fax Number	:	253-852-9210

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	02/09/2012

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