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General NPI Number Information
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NPI Number | 1215456520
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Entity Type | Individual
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Provider Name | MATTHEW KERR L.AC.
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Gender | Male
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Dates
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Enumeration Date | 09/18/2017
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Last Update Date | 09/18/2017
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Provider Practice Location Address
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Address Line | 216 W JACKSON BLVD
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City | CHICAGO
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State | IL
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Zip | 60606-6909
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Country | US
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Telephone | 312-216-2412
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Fax |
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Provider Business Mailing Address
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Address Line | 5820 N KENMORE AVE
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City | CHICAGO
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State | IL
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Zip | 60660-3765
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Country | US
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Telephone | 773-456-2557
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 198.001053
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License Number State | IL
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