Healthcare Provider Details

I. General information

NPI: 1679819353
Provider Name (Legal Business Name): KENTUCKY OSTEO RELIEF INSTITUTE PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2012
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 MAJESTIC DR STE 270
LEXINGTON KY
40513-1897
US

IV. Provider business mailing address

1019 MAJESTIC DR STE 270
LEXINGTON KY
40513-1897
US

V. Phone/Fax

Practice location:
  • Phone: 859-446-5603
  • Fax: 859-223-0494
Mailing address:
  • Phone: 859-446-5603
  • Fax: 859-223-0494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY SCATENA
Title or Position: STAFF PROVIDER
Credential: DC
Phone: 859-446-5603