Provider Demographics
NPI:1710933528
Name:ZIMMERMAN, MARK T (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:T
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 1:2701 KURT ST
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6515
Mailing Address - Country:US
Mailing Address - Phone:352-357-1122
Mailing Address - Fax:352-357-3466
Practice Address - Street 1:2701 KURT ST
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6515
Practice Address - Country:US
Practice Address - Phone:352-357-1122
Practice Address - Fax:352-357-3466
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9512111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNV05744Medicare UPIN
TN3973640Medicare ID - Type Unspecified