Provider Demographics
NPI:1063000149
Name:GOULD, KELSEY A (DC)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:A
Last Name:GOULD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 W JOHNSBURG RD STE 1
Mailing Address - Street 2:
Mailing Address - City:JOHNSBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60051-5213
Mailing Address - Country:US
Mailing Address - Phone:815-344-0113
Mailing Address - Fax:
Practice Address - Street 1:2302 W JOHNSBURG RD STE 1
Practice Address - Street 2:
Practice Address - City:JOHNSBURG
Practice Address - State:IL
Practice Address - Zip Code:60051-5213
Practice Address - Country:US
Practice Address - Phone:815-344-0113
Practice Address - Fax:815-344-8124
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013618111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor