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General NPI Number Information
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NPI Number | 1730483967
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Entity Type | Organization
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Legal Business Name | KENTUCKY OSTEO RELIEF INSTITUTE
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Dates
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Enumeration Date | 01/03/2011
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Last Update Date | 01/03/2011
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Provider Practice Location Address
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Address Line | 1019 MAJESTIC DR SUITE 160
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City | LEXINGTON
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State | KY
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Zip | 40513-1496
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Country | US
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Telephone | 859-223-0488
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Fax | 859-223-0494
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Provider Business Mailing Address
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Address Line | 1019 MAJESTIC DR SUITE 160
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City | LEXINGTON
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State | KY
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Zip | 40513-1496
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Country | US
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Telephone | 859-223-0488
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Fax | 859-223-0494
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANTHONY J SCATENA
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Credential | DC
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Telephone | 859-223-0488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | 4994
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License Number State | KY
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