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General NPI Number Information
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NPI Number | 1295340735
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Entity Type | Individual
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Provider Name | KACEY JO SKELLY DC
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Gender | Female
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Dates
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Enumeration Date | 09/11/2020
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 3819 4 MILE RD N STE B
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City | TRAVERSE CITY
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State | MI
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Zip | 49686-9344
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Country | US
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Telephone | 231-421-7251
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Fax |
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Provider Business Mailing Address
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Address Line | 3819 4 MILE RD N STE B
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City | TRAVERSE CITY
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State | MI
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Zip | 49686-9344
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Country | US
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Telephone | 231-421-7251
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3702
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301401536
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License Number State | MI
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