MEDICARE: KOCIOLEK CHIROPRACTIC CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1194534156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOCIOLEK CHIROPRACTIC CENTER, LLC

Provider Business Mailing Address
First Line	:	101 ELEGANCE WAY
Second Line	:
City	:	ELIZABETHTOWN
State	:	KY
Zip	:	42701-8999
Country	:	US
Telephone Number	:	515-783-6288
Fax Number	:

Provider Business Practice Location Address
First Line	:	4452 DIXIE HWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40216-2866
Country	:	US
Telephone Number	:	502-448-5241
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. RAYMND STEPHEN KOCIOLEK
Credential	:	DC
Telephone Number	:	515-783-6288

Provider Enumeration Date	:	01/04/2025
Last Update Date	:	01/04/2025

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