Provider Demographics
NPI:1417985920
Name:ZIMMERMAN, JOHN S (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 N DIAMOND BAR BLVD
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-1007
Mailing Address - Country:US
Mailing Address - Phone:909-861-2611
Mailing Address - Fax:909-860-2314
Practice Address - Street 1:566 N DIAMOND BAR BLVD
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-1007
Practice Address - Country:US
Practice Address - Phone:909-861-2611
Practice Address - Fax:909-860-2314
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13160171100000X
CADC26261111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU76392Medicare UPIN
CA312326291Medicare ID - Type Unspecified