MEDICARE: DR. KELSEY CHERYL RODEHORST 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
1	171100000X	Acupuncturist	198.011986	IL

General Provider Information

NPI Number	:	1093651531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELSEY CHERYL RODEHORST L. AC

Provider Business Mailing Address
First Line	:	1422 W CATALPA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1212
Country	:	US
Telephone Number	:	208-721-8992
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 REVERE DR STE 907
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-1581
Country	:	US
Telephone Number	:	224-213-7070
Fax Number	:

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

Provider Enumeration Date	:	04/27/2026
Last Update Date	:	04/27/2026

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