Healthcare Provider Details

I. General information

NPI: 1003037151
Provider Name (Legal Business Name): ZIMMERMANN CHIROPRACTIC AND WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 LAKE AVE SUITE 3
MANCHESTER NH
03103-2734
US

IV. Provider business mailing address

700 LAKE AVE SUITE 3
MANCHESTER NH
03103-2734
US

V. Phone/Fax

Practice location:
  • Phone: 603-668-7070
  • Fax: 603-668-5755
Mailing address:
  • Phone: 603-668-7070
  • Fax: 603-668-5755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1000492
License Number StateNH

VIII. Authorized Official

Name: DR. KEITH JOHN ZIMMERMANN
Title or Position: OWNER
Credential: DC
Phone: 603-668-7070