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NPI Code Detail

MEDICARE: MS. ELIZABETH KETTNER L.AC

MEDICARE: MS. ELIZABETH KETTNER L.AC
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
1171100000XAcupuncturist198.001201IL

General Provider Information

NPI Number : 1225447550
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ELIZABETH KETTNER L.AC
Provider Business Mailing Address
First Line : 79 E 16TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60616-5520
Country : US
Telephone Number : 312-842-1229
Fax Number :
Provider Business Practice Location Address
First Line : 79 E 16TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60616-5520
Country : US
Telephone Number : 312-842-1229
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2014
Last Update Date : 08/12/2014

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