MEDICARE: DR. KACEY JO SKELLY 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	111N00000X	Chiropractor	3702	MA
2	111N00000X	Chiropractor	2301401536	MI

General Provider Information

NPI Number	:	1295340735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KACEY JO SKELLY DC

Provider Business Mailing Address
First Line	:	3819 4 MILE RD N STE B
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-9344
Country	:	US
Telephone Number	:	231-421-7251
Fax Number	:

Provider Business Practice Location Address
First Line	:	3819 4 MILE RD N STE B
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-9344
Country	:	US
Telephone Number	:	231-421-7251
Fax Number	:

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

Provider Enumeration Date	:	09/11/2020
Last Update Date	:	01/02/2025

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