Provider Demographics
NPI:1407033707
Name:KAMINSKI CHIROPRACTIC LIFE CENTER
Entity Type:Organization
Organization Name:KAMINSKI CHIROPRACTIC LIFE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:J
Authorized Official - Last Name:KAMINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:313-884-5477
Mailing Address - Street 1:10575 MORANG DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-1880
Mailing Address - Country:US
Mailing Address - Phone:313-884-5477
Mailing Address - Fax:
Practice Address - Street 1:10575 MORANG DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-1880
Practice Address - Country:US
Practice Address - Phone:313-884-5477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAMINSKI CHIROPRACTIC LIFE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRK003072111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty