MEDICARE: CASCADE SPORTS THERAPY PLLC

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

General Provider Information

NPI Number	:	1063363687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASCADE SPORTS THERAPY PLLC

Provider Business Mailing Address
First Line	:	3620 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-3516
Country	:	US
Telephone Number	:	872-239-4425
Fax Number	:

Provider Business Practice Location Address
First Line	:	3620 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-3516
Country	:	US
Telephone Number	:	872-239-4425
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. HALI DETERS
Credential	:	DC
Telephone Number	:	872-239-4425

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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