Healthcare Provider Details

I. General information

NPI: 1760406581
Provider Name (Legal Business Name): TIMOTHY LEE ZIMMERMAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 N 6TH ST
DENVER PA
17517-1511
US

IV. Provider business mailing address

809 N 6TH ST
DENVER PA
17517-1511
US

V. Phone/Fax

Practice location:
  • Phone: 717-336-2234
  • Fax: 717-336-7048
Mailing address:
  • Phone: 717-336-2234
  • Fax: 717-336-7048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC002596L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: