Provider Demographics
NPI:1336557750
Name:WAKE FAMILY CHIROPRACTIC PA
Entity Type:Organization
Organization Name:WAKE FAMILY CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-404-9171
Mailing Address - Street 1:12335 WAKE UNION CHURCH RD
Mailing Address - Street 2:204
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4527
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12335 WAKE UNION CHURCH RD
Practice Address - Street 2:204
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-4527
Practice Address - Country:US
Practice Address - Phone:919-404-9171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4344261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center