Healthcare Provider Details

I. General information

NPI: 1790266591
Provider Name (Legal Business Name): KAMINSKY CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 GODWIN AVE STE 7
WYCKOFF NJ
07481
US

IV. Provider business mailing address

15-18 PARMELEE AVE
FAIR LAWN NJ
07410-1915
US

V. Phone/Fax

Practice location:
  • Phone: 201-485-7518
  • Fax:
Mailing address:
  • Phone: 954-234-5268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JEROLD KAMINSKY
Title or Position: PRESIDENT
Credential: DC
Phone: 954-234-5268