Provider Demographics
NPI:1043740384
Name:ZIMMERMANN, AMANDA SUSAN (DC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:SUSAN
Last Name:ZIMMERMANN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:SUSAN
Other - Last Name:ZAGORSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36925 DETROIT RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011
Mailing Address - Country:US
Mailing Address - Phone:440-937-8480
Mailing Address - Fax:330-723-1881
Practice Address - Street 1:36925 DETROIT RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011
Practice Address - Country:US
Practice Address - Phone:440-937-8480
Practice Address - Fax:330-723-1881
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-04695111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDC-04695OtherLICENSE NUMBER