Provider Demographics
NPI:1407369036
Name:KOCIOLEK, RAYMOND STEPHEN (DC, MS, ATC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:STEPHEN
Last Name:KOCIOLEK
Suffix:
Gender:M
Credentials:DC, MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 TOWNE DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-8460
Mailing Address - Country:US
Mailing Address - Phone:270-900-4030
Mailing Address - Fax:270-900-0489
Practice Address - Street 1:181 TOWNE DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-8460
Practice Address - Country:US
Practice Address - Phone:270-900-4030
Practice Address - Fax:270-900-0489
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
KY5599111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100599360Medicaid