Provider Demographics
NPI:1851378376
Name:FIMRITE, TAMMY R (DC)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:R
Last Name:FIMRITE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 PARK AVE SOUTH
Mailing Address - Street 2:
Mailing Address - City:ST. CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301
Mailing Address - Country:US
Mailing Address - Phone:320-253-5650
Mailing Address - Fax:
Practice Address - Street 1:203 PARK AVE S
Practice Address - Street 2:SUITE 101
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-3779
Practice Address - Country:US
Practice Address - Phone:320-253-5650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN862171100000X
MN4006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN624731800Medicaid
MN0016JOtherHSM ELECT
MN181M9FIOtherBCBS
MN350002764OtherRAILROAD
MN625801OtherCHIROCARE
MN181M9FIOtherBCBS
MNU86049Medicare UPIN