Provider Demographics
NPI:1356544753
Name:ZIMMERMAN, CAROL ANNE (DC LAC)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANNE
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:DC LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POB 445
Mailing Address - Street 2:
Mailing Address - City:NAALEHU
Mailing Address - State:HI
Mailing Address - Zip Code:96772
Mailing Address - Country:US
Mailing Address - Phone:808-929-9229
Mailing Address - Fax:
Practice Address - Street 1:525 LOTUS BLOSSOM LANE
Practice Address - Street 2:
Practice Address - City:OCEAN VIEW
Practice Address - State:HI
Practice Address - Zip Code:96737
Practice Address - Country:US
Practice Address - Phone:808-929-9229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI524111N00000X
HI344171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI53629OtherHMSA
HI53629OtherHMSA
0000QCCMRMedicare UPIN