Provider Demographics
NPI:1710073465
Name:ZIMMERMAN, GARY F (DC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:F
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:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-0186
Mailing Address - Country:US
Mailing Address - Phone:541-276-8276
Mailing Address - Fax:
Practice Address - Street 1:409 SW 4TH ST
Practice Address - Street 2:STE A
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-2068
Practice Address - Country:US
Practice Address - Phone:541-276-1097
Practice Address - Fax:541-966-9713
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1266111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000QGBJNMedicare ID - Type UnspecifiedMEDICARE PROVIDER ID #