Provider Demographics
NPI:1255381828
Name:KAMINSKI PAIN AND PERFORMANCE CARE,P.C.
Entity type:Organization
Organization Name:KAMINSKI PAIN AND PERFORMANCE CARE,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-344-0777
Mailing Address - Street 1:4626 PROGRESS DR STE D
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3485
Mailing Address - Country:US
Mailing Address - Phone:563-344-0777
Mailing Address - Fax:563-344-0888
Practice Address - Street 1:2525 KIMBERLY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3538
Practice Address - Country:US
Practice Address - Phone:563-344-0777
Practice Address - Fax:563-344-0888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06254111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAU80771Medicare UPIN
IA20023Medicare ID - Type Unspecified