Provider Demographics
NPI:1104006972
Name:ZIMMER, SUSAN M (DC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:9142 DOLES RD.
Mailing Address - City:IVOR
Mailing Address - State:VA
Mailing Address - Zip Code:23866-0417
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9142 DOLES RD
Practice Address - Street 2:PO B 417
Practice Address - City:IVOR
Practice Address - State:VA
Practice Address - Zip Code:23866-0417
Practice Address - Country:US
Practice Address - Phone:757-859-9142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor