Provider Demographics
NPI:1235355850
Name:ZIMMERMAN, JANNELL LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:JANNELL
Middle Name:LYNN
Last Name:ZIMMERMAN
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 1:9817 E 37TH CT
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-2401
Mailing Address - Country:US
Mailing Address - Phone:191-870-6008
Mailing Address - Fax:
Practice Address - Street 1:3336 E 32ND ST STE 103
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-4446
Practice Address - Country:US
Practice Address - Phone:918-895-8899
Practice Address - Fax:918-512-4442
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3778111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1962647693OtherORGANIZATION NPI