Healthcare Provider Details

I. General information

NPI: 1679569263
Provider Name (Legal Business Name): DAVID WIMMER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 GRAVES MILL RD SUITE E
FOREST VA
24551-4296
US

IV. Provider business mailing address

2203 GRAVES MILL RD SUITE E
FOREST VA
24551-4296
US

V. Phone/Fax

Practice location:
  • Phone: 434-845-9000
  • Fax: 434-455-2276
Mailing address:
  • Phone: 434-845-9000
  • Fax: 434-455-2276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104556254
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: