Healthcare Provider Details

I. General information

NPI: 1689436867
Provider Name (Legal Business Name): SCOLI TRANSFORMATION CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 COMMERCIAL DR
LOUISVILLE KY
40223-3962
US

IV. Provider business mailing address

9393 AIKEN RD
LOUISVILLE KY
40245-5020
US

V. Phone/Fax

Practice location:
  • Phone: 937-638-8726
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: XAVIER COUNTS
Title or Position: OWNER/HEAD CLINICIAN
Credential: DC
Phone: 937-638-8726