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NPI Code Detail

MEDICARE: CARLY IACULLO

MEDICARE: CARLY IACULLO
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
1171100000XAcupuncturist198.011985IL

General Provider Information

NPI Number : 1710828769
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLY IACULLO
Provider Business Mailing Address
First Line : 121 W CHESTNUT ST APT 1308
Second Line :
City : CHICAGO
State : IL
Zip : 60610-3155
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1111 W MADISON ST STE 2
Second Line :
City : CHICAGO
State : IL
Zip : 60607-2055
Country : US
Telephone Number : 773-234-1042
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2026
Last Update Date : 04/03/2026

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Directions to “ CARLY IACULLO ” Practice Location

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