Provider Demographics
NPI:1407912454
Name:ZIMMERMAN, ADRIENNE ANNE (DC)
Entity Type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:ANNE
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 1:12682 SPRINGBROOK DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-5076
Mailing Address - Country:US
Mailing Address - Phone:858-451-2120
Mailing Address - Fax:858-486-1245
Practice Address - Street 1:16496 BERNARDO CENTER DR
Practice Address - Street 2:310
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2524
Practice Address - Country:US
Practice Address - Phone:858-451-2120
Practice Address - Fax:858-486-1245
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16092111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33-0199977OtherTAX ID
CADC16092Medicare ID - Type Unspecified