Healthcare Provider Details

I. General information

NPI: 1972666394
Provider Name (Legal Business Name): WIMMER CHIROPRACTIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 05/08/2008
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: DR. DAVID WIMMER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 434-845-9000