Provider Demographics
NPI:1184721326
Name:ZIMBARDO, JONATHAN S (DC, CCSP, DIACN)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:S
Last Name:ZIMBARDO
Suffix:
Gender:M
Credentials:DC, CCSP, DIACN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709-4419
Mailing Address - Country:US
Mailing Address - Phone:914-337-3737
Mailing Address - Fax:914-771-6049
Practice Address - Street 1:274 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:EASTCHESTER
Practice Address - State:NY
Practice Address - Zip Code:10709
Practice Address - Country:US
Practice Address - Phone:914-337-3737
Practice Address - Fax:914-771-6049
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006140111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX7U671OtherBCBS
NYX7U671OtherBCBS