Healthcare Provider Details

I. General information

NPI: 1710056114
Provider Name (Legal Business Name): JARRETT DANIEL KAMINSKY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 ALBRIGHT AVE
SCRANTON PA
18508-2500
US

IV. Provider business mailing address

909 ALBRIGHT AVE
SCRANTON PA
18508-2500
US

V. Phone/Fax

Practice location:
  • Phone: 570-348-1158
  • Fax: 570-348-1858
Mailing address:
  • Phone: 570-348-1158
  • Fax: 570-348-1858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00034241
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC008802
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: