MEDICARE: DR. JERALD GREG ZIMMERMAN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH00002137	WA

General Provider Information

NPI Number	:	1285765990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERALD GREG ZIMMERMAN D.C.

Provider Business Mailing Address
First Line	:	2625 MARTIN WAY E STE A
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-4900
Country	:	US
Telephone Number	:	360-352-5145
Fax Number	:	360-956-9004

Provider Business Practice Location Address
First Line	:	2625 MARTIN WAY E STE A
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-4900
Country	:	US
Telephone Number	:	360-352-5145
Fax Number	:	360-956-9004

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	07/08/2007

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