Healthcare Provider Details

I. General information

NPI: 1063000149
Provider Name (Legal Business Name): KELSEY A GOULD DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 E 95TH ST
CHICAGO IL
60617-4710
US

IV. Provider business mailing address

1925 E 95TH ST
CHICAGO IL
60617-4710
US

V. Phone/Fax

Practice location:
  • Phone: 312-245-9797
  • Fax: 312-283-4209
Mailing address:
  • Phone: 312-245-9797
  • Fax: 312-283-4209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.013618
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number038013618
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: