MEDICARE: KELSEY A GOULD DC

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	111NR0400X	Rehabilitation Chiropractor	038013618	IL
2	111N00000X	Chiropractor	038.013618	IL

General Provider Information

NPI Number	:	1063000149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY A GOULD DC

Provider Business Mailing Address
First Line	:	1925 E 95TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-4710
Country	:	US
Telephone Number	:	312-245-9797
Fax Number	:	312-283-4209

Provider Business Practice Location Address
First Line	:	1925 E 95TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-4710
Country	:	US
Telephone Number	:	312-245-9797
Fax Number	:	312-283-4209

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2021
Last Update Date	:	04/29/2025

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