Provider Demographics
NPI:1275724791
Name:R V ZIMMER, D.C., INC
Entity type:Organization
Organization Name:R V ZIMMER, D.C., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:V
Authorized Official - Last Name:ZIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:937-294-1484
Mailing Address - Street 1:2436 E DOROTHY LN
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1155
Mailing Address - Country:US
Mailing Address - Phone:937-294-1484
Mailing Address - Fax:937-294-7542
Practice Address - Street 1:2436 E DOROTHY LN
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45420-1155
Practice Address - Country:US
Practice Address - Phone:937-294-1484
Practice Address - Fax:937-294-7542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH547111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherTAX ID
OH=========-00OtherBWC
OH=========OtherTAX ID
OHT-46444Medicare UPIN