Provider Demographics
NPI:1225106099
Name:ZIMMERMAN, CHAD ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
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 1:4800 BASELINE RD STE C110
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-2643
Mailing Address - Country:US
Mailing Address - Phone:303-494-2800
Mailing Address - Fax:303-499-8007
Practice Address - Street 1:4800 BASELINE RD STE C110
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2643
Practice Address - Country:US
Practice Address - Phone:303-494-2800
Practice Address - Fax:303-499-8007
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5765111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU79334Medicare UPIN
COC803798Medicare PIN