Provider Demographics
NPI:1255335683
Name:KAMINSKY, DAVID MARK (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARK
Last Name:KAMINSKY
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 1:8505 FENTON ST
Mailing Address - Street 2:STE 204
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4499
Mailing Address - Country:US
Mailing Address - Phone:301-587-7555
Mailing Address - Fax:
Practice Address - Street 1:8505 FENTON ST
Practice Address - Street 2:STE 204
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4499
Practice Address - Country:US
Practice Address - Phone:301-587-7555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01978111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKBW2OtherBLUECROSS BLUESHIELD
DCF923-0001OtherBLUECROSS BLUESHIELD