Provider Demographics
NPI:1629071519
Name:ZIMMER, ROBERT V (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:V
Last Name:ZIMMER
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 1:2436 E DOROTHY LN
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1155
Mailing Address - Country:US
Mailing Address - Phone:937-294-1484
Mailing Address - Fax:937-294-7542
Practice Address - Street 1:2436 E DOROTHY LN
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45420-1155
Practice Address - Country:US
Practice Address - Phone:937-294-1484
Practice Address - Fax:937-294-7542
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH547111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH310997407-00OtherBWC
OH310997407OtherTAX ID
OHT-46444Medicare UPIN