Provider Demographics
NPI:1760406581
Name:ZIMMERMAN, TIMOTHY LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:LEE
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 1:809 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:PA
Mailing Address - Zip Code:17517-1511
Mailing Address - Country:US
Mailing Address - Phone:717-336-2234
Mailing Address - Fax:717-336-7048
Practice Address - Street 1:809 N 6TH ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:PA
Practice Address - Zip Code:17517-1511
Practice Address - Country:US
Practice Address - Phone:717-336-2234
Practice Address - Fax:717-336-7048
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002596L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAZI404-668Medicare ID - Type Unspecified
PAT30187Medicare UPIN