Individual
KELLY MULLEN DESIERTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.AC.
Contact information
Practice address
5330 W DEVON AVE, SUITE 5, CHICAGO, IL 60646-4148
(773) 682-7124
Mailing address
5330 W DEVON AVE, SUITE 5, CHICAGO, IL 60646-4148
(773) 682-7124
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
198.001110
IL
Other
Enumeration date
07/29/2015
Last updated
07/29/2015
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