Provider Demographics
NPI:1770531345
Name:ZIMMER, BRIAN MATTHEW (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MATTHEW
Last Name:ZIMMER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4318 DEXTER AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504-2444
Mailing Address - Country:US
Mailing Address - Phone:814-825-2196
Mailing Address - Fax:814-825-2987
Practice Address - Street 1:4318 DEXTER AVE
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-2444
Practice Address - Country:US
Practice Address - Phone:814-825-2196
Practice Address - Fax:814-825-2987
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006853L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
804591OtherHIGHMARK BLUE SHIELD
PA0016435980003Medicaid
PA326599OtherUPMC
PA343846OtherHEALTH AMERICA
PA343846OtherHEALTH AMERICA
PA804591LCDMedicare PIN