Provider Demographics
NPI:1659493112
Name:ZIMMERMAN, JASON EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:EDWARD
Last Name:ZIMMERMAN
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 1:9864 LYNDALE AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-4731
Mailing Address - Country:US
Mailing Address - Phone:952-948-9225
Mailing Address - Fax:952-888-6011
Practice Address - Street 1:9864 LYNDALE AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-4731
Practice Address - Country:US
Practice Address - Phone:952-948-9225
Practice Address - Fax:952-888-6011
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3666111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor