Provider Demographics
NPI:1982926036
Name:ZIMMER, JOHN C (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
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 1:58 FULLER ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-1926
Mailing Address - Country:US
Mailing Address - Phone:781-828-2682
Mailing Address - Fax:
Practice Address - Street 1:58 FULLER ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-1926
Practice Address - Country:US
Practice Address - Phone:781-828-2682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor