Provider Demographics
NPI:1750033460
Name:KAMINSKI, REID STEPHEN (DC)
Entity Type:Individual
Prefix:
First Name:REID
Middle Name:STEPHEN
Last Name:KAMINSKI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34100 WOODWARD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-0962
Mailing Address - Country:US
Mailing Address - Phone:248-645-6070
Mailing Address - Fax:
Practice Address - Street 1:34100 WOODWARD AVE STE 100
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-0962
Practice Address - Country:US
Practice Address - Phone:248-645-6070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301404217111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor