Provider Demographics
NPI:1780860619
Name:ZIMMER FAMILY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:ZIMMER FAMILY CHIROPRACTIC, PC
Other - Org Name:ZIMMER CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:ZIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, DC
Authorized Official - Phone:317-813-1998
Mailing Address - Street 1:9757 WESTPOINT DR STE 500
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3265
Mailing Address - Country:US
Mailing Address - Phone:317-813-1998
Mailing Address - Fax:317-813-1997
Practice Address - Street 1:9757 WESTPOINT DR STE 500
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3265
Practice Address - Country:US
Practice Address - Phone:317-813-1998
Practice Address - Fax:317-813-1997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000205170OtherBCBS LEGACY PIN
IN000000205170OtherBCBS LEGACY PIN
INU75370Medicare UPIN