Healthcare Provider Details

I. General information

NPI: 1962444653
Provider Name (Legal Business Name): LIFESTYLE RESUMPTION INTEGRATIVE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2182 DIXIE HWY
FT MITCHELL KY
41017-2902
US

IV. Provider business mailing address

2182 DIXIE HWY
FT MITCHELL KY
41017-2902
US

V. Phone/Fax

Practice location:
  • Phone: 859-344-6001
  • Fax: 859-344-6005
Mailing address:
  • Phone: 859-344-6001
  • Fax: 859-344-6005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. KLAUDE P KOCAN
Title or Position: OWNER
Credential: DC
Phone: 859-344-6001