Healthcare Provider Details

I. General information

NPI: 1407369036
Provider Name (Legal Business Name): RAYMOND STEPHEN KOCIOLEK DC, MS, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 TOWNE DR
ELIZABETHTOWN KY
42701-8460
US

IV. Provider business mailing address

181 TOWNE DR
ELIZABETHTOWN KY
42701-8460
US

V. Phone/Fax

Practice location:
  • Phone: 270-900-4030
  • Fax: 270-900-0489
Mailing address:
  • Phone: 270-900-4030
  • Fax: 270-900-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5599
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: