MEDICARE: KATELYN SEGER 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	198.001385	IL

General Provider Information

NPI Number	:	1932626165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN SEGER LAC

Provider Business Mailing Address
First Line	:	4018 N HAMLIN AVE # 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-2106
Country	:	US
Telephone Number	:	872-888-3246
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	:	08/28/2017
Last Update Date	:	08/16/2019

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Directions to “ KATELYN SEGER LAC” Practice Location

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