MEDICARE: KOLOFER CHIROPRACTIC INC.

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	:	1457846255
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOLOFER CHIROPRACTIC INC.

Provider Business Mailing Address
First Line	:	1428 PHILLIPS LN STE 300
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-2552
Country	:	US
Telephone Number	:	805-543-8688
Fax Number	:

Provider Business Practice Location Address
First Line	:	1428 PHILLIPS LN STE 300
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-2552
Country	:	US
Telephone Number	:	805-543-8688
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	SCOTT KOLOFER
Credential	:	DC
Telephone Number	:	805-543-8688

Provider Enumeration Date	:	06/25/2018
Last Update Date	:	06/25/2018

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