Provider Demographics
NPI:1972666394
Name:WIMMER CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:WIMMER CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:434-845-9000
Mailing Address - Street 1:2203 GRAVES MILL RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-4296
Mailing Address - Country:US
Mailing Address - Phone:434-845-9000
Mailing Address - Fax:434-455-2276
Practice Address - Street 1:2203 GRAVES MILL RD
Practice Address - Street 2:SUITE E
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-4296
Practice Address - Country:US
Practice Address - Phone:434-845-9000
Practice Address - Fax:434-455-2276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556254111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA144638OtherANTHEM
VI1799336OtherCIGNA
VAC09178Medicare ID - Type Unspecified
VADB9272Medicare ID - Type UnspecifiedRAILROAD
VAV01153Medicare UPIN