Provider Demographics
NPI:1952789737
Name:NIMOCK, DAVID (LMP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:NIMOCK
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-9514
Mailing Address - Country:US
Mailing Address - Phone:720-495-7658
Mailing Address - Fax:
Practice Address - Street 1:1012 DUPONT ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-3112
Practice Address - Country:US
Practice Address - Phone:720-581-1102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60532055225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist