Provider Demographics
NPI:1144594110
Name:ZIMMERMAN, KYLE ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:ROBERT
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2914
Mailing Address - Country:US
Mailing Address - Phone:989-723-2039
Mailing Address - Fax:989-725-7723
Practice Address - Street 1:210 W MAIN ST
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2914
Practice Address - Country:US
Practice Address - Phone:989-723-2039
Practice Address - Fax:989-725-7723
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009865111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor