MEDICARE: DR. RANDY THOMAS ZIMMERMAN DC

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	006605	MO

General Provider Information

NPI Number	:	1407886245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDY THOMAS ZIMMERMAN DC

Provider Business Mailing Address
First Line	:	1307 B VILLAGE DRIVE
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-2457
Country	:	US
Telephone Number	:	816-390-9900
Fax Number	:	816-232-4357

Provider Business Practice Location Address
First Line	:	1307 B VILLAGE DRIVE
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-2457
Country	:	US
Telephone Number	:	816-390-9900
Fax Number	:	816-232-4357

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	07/08/2007

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