Provider Demographics
NPI:1649288630
Name:ZIMMERER, JULIE (DC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:ZIMMERER
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 1:31610 RAILROAD CANYON RD
Mailing Address - Street 2:#5
Mailing Address - City:CANYON LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92587-9454
Mailing Address - Country:US
Mailing Address - Phone:951-244-7622
Mailing Address - Fax:951-246-2657
Practice Address - Street 1:31610 RAILROAD CANYON RD
Practice Address - Street 2:#5
Practice Address - City:CANYON LAKE
Practice Address - State:CA
Practice Address - Zip Code:92587-9454
Practice Address - Country:US
Practice Address - Phone:951-244-7622
Practice Address - Fax:951-246-2657
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17619111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0176190Medicare ID - Type Unspecified