MEDICARE: WAKE FAMILY CHIROPRACTIC PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	4344	NC

General Provider Information

NPI Number	:	1336557750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAKE FAMILY CHIROPRACTIC PA

Provider Business Mailing Address
First Line	:	12335 WAKE UNION CHURCH RD
Second Line	:	204
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-4527
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12335 WAKE UNION CHURCH RD
Second Line	:	204
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-4527
Country	:	US
Telephone Number	:	919-404-9171
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRANDON KAMINSKI
Credential	:	D.C.
Telephone Number	:	919-404-9171

Provider Enumeration Date	:	07/29/2014
Last Update Date	:	07/29/2014

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