MEDICARE: KASEY SPORTS ACUPUNCTURE PLLC

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

General Provider Information

NPI Number	:	1881589927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KASEY SPORTS ACUPUNCTURE PLLC

Provider Business Mailing Address
First Line	:	2848 W BARRY AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-8487
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3620 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-3516
Country	:	US
Telephone Number	:	312-877-5881
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	KASEY MCKENNEY
Credential	:	L.AC
Telephone Number	:	317-496-7338

Provider Enumeration Date	:	06/10/2025
Last Update Date	:	06/10/2025

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