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General NPI Number Information
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NPI Number | 1407019698
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC CARE GRAND TRAVERSE, PC
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Dates
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Enumeration Date | 07/08/2008
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 620 SECOND ST
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-2272
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Country | US
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Telephone | 231-922-0233
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Fax | 231-941-9832
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Provider Business Mailing Address
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Address Line | 620 SECOND ST
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-2272
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Country | US
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Telephone | 231-922-0233
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Fax | 231-941-9832
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Authorized Official
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Title or Position | OWNER
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Name | MARK J ZIMMER
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Credential | DC
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Telephone | 231-922-0233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301005511
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License Number State | MI
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