Provider Demographics
NPI:1770898553
Name:MICHAEL C ZIMMER DC PC
Entity type:Organization
Organization Name:MICHAEL C ZIMMER DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CONWAY
Authorized Official - Last Name:ZIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-291-3666
Mailing Address - Street 1:11705 DORSETT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-2519
Mailing Address - Country:US
Mailing Address - Phone:314-291-3666
Mailing Address - Fax:314-291-3668
Practice Address - Street 1:11705 DORSETT RD STE 101
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-2519
Practice Address - Country:US
Practice Address - Phone:314-291-3666
Practice Address - Fax:314-291-3668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-17
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE 003583111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT42956Medicare UPIN