Provider Demographics
NPI:1235230558
Name:SCIORTINO, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SCIORTINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2869 US HIGHWAY 41 N STE B
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2048
Mailing Address - Country:US
Mailing Address - Phone:270-844-8100
Mailing Address - Fax:270-844-8102
Practice Address - Street 1:2869 US HIGHWAY 41 N STE B
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2048
Practice Address - Country:US
Practice Address - Phone:270-844-8100
Practice Address - Fax:270-844-8102
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4767111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
11069225OtherCAQH
000000276089OtherANTHEM
KY85002624Medicaid
KY6101901Medicare PIN
U94426Medicare UPIN