Provider Demographics
NPI:1609825355
Name:ZIMMER, CHRISTOPHER J (DC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:J
Last Name:ZIMMER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:CHRISTOPHER
Other - Middle Name:J
Other - Last Name:ZIMMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:447 S WATER ST
Mailing Address - Street 2:
Mailing Address - City:MARINE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48039-1695
Mailing Address - Country:US
Mailing Address - Phone:810-765-5622
Mailing Address - Fax:810-765-8374
Practice Address - Street 1:447 S WATER ST
Practice Address - Street 2:
Practice Address - City:MARINE CITY
Practice Address - State:MI
Practice Address - Zip Code:48039-1695
Practice Address - Country:US
Practice Address - Phone:810-765-5622
Practice Address - Fax:810-765-8374
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005003111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3212436Medicaid
MIT33579Medicare UPIN
MI0G45051Medicare ID - Type Unspecified