MEDICARE: MRS. CADY ELREDY LAC

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	198001409	IL
2	171100000X	Acupuncturist	198.001409	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	198.001409	OTHER	IL	STATE OF ILLINOIS DEPARTMENT OF FINANCIAL & PROFESSIONAL REGULATION

General Provider Information

NPI Number	:	1497219349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CADY ELREDY LAC

Provider Business Mailing Address
First Line	:	922 NORTH BLVD APT 408
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60301-1242
Country	:	US
Telephone Number	:	469-777-1133
Fax Number	:

Provider Business Practice Location Address
First Line	:	3234 W FULLERTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2594
Country	:	US
Telephone Number	:	773-466-9882
Fax Number	:

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

Provider Enumeration Date	:	01/24/2019
Last Update Date	:	07/07/2019

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