MEDICARE: DR. JANNELL LYNN ZIMMERMAN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3778	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1962647693	OTHER		ORGANIZATION NPI

General Provider Information

NPI Number	:	1235355850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANNELL LYNN ZIMMERMAN D.C.

Provider Business Mailing Address
First Line	:	9817 E 37TH CT
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74146-2401
Country	:	US
Telephone Number	:	191-870-6008
Fax Number	:

Provider Business Practice Location Address
First Line	:	3336 E 32ND ST STE 103
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-4446
Country	:	US
Telephone Number	:	918-895-8899
Fax Number	:	918-512-4442

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	01/04/2022

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