Provider Demographics
NPI:1760735641
Name:KAMINSKI, PAUL ALAN (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ALAN
Last Name:KAMINSKI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:ALAN
Other - Last Name:KAMINSKI
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1845 R W BERENDS DR SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-4955
Mailing Address - Country:US
Mailing Address - Phone:616-538-2200
Mailing Address - Fax:616-301-0419
Practice Address - Street 1:1845 R W BERENDS DR SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-4955
Practice Address - Country:US
Practice Address - Phone:616-538-2200
Practice Address - Fax:616-301-0419
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009966111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor