MEDICARE: KENTUCKY OSTEO RELIEF INSTITUTE

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	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	4994	KY

General Provider Information

NPI Number	:	1730483967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENTUCKY OSTEO RELIEF INSTITUTE

Provider Business Mailing Address
First Line	:	1019 MAJESTIC DR
Second Line	:	SUITE 160
City	:	LEXINGTON
State	:	KY
Zip	:	40513-1496
Country	:	US
Telephone Number	:	859-223-0488
Fax Number	:	859-223-0494

Provider Business Practice Location Address
First Line	:	1019 MAJESTIC DR
Second Line	:	SUITE 160
City	:	LEXINGTON
State	:	KY
Zip	:	40513-1496
Country	:	US
Telephone Number	:	859-223-0488
Fax Number	:	859-223-0494

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANTHONY J SCATENA
Credential	:	DC
Telephone Number	:	859-223-0488

Provider Enumeration Date	:	01/03/2011
Last Update Date	:	01/03/2011

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