Healthcare Provider Details

I. General information

NPI: 1417985920
Provider Name (Legal Business Name): JOHN S ZIMMERMAN D.C., L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 N DIAMOND BAR BLVD
DIAMOND BAR CA
91765-1007
US

IV. Provider business mailing address

566 N DIAMOND BAR BLVD
DIAMOND BAR CA
91765-1007
US

V. Phone/Fax

Practice location:
  • Phone: 909-861-2611
  • Fax: 909-860-2314
Mailing address:
  • Phone: 909-861-2611
  • Fax: 909-860-2314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95212015
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number13160
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95039309
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC26261
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: