Provider Demographics
NPI:1285765990
Name:ZIMMERMAN, JERALD GREG (DC)
Entity type:Individual
Prefix:DR
First Name:JERALD
Middle Name:GREG
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 MARTIN WAY E STE A
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4900
Mailing Address - Country:US
Mailing Address - Phone:360-352-5145
Mailing Address - Fax:360-956-9004
Practice Address - Street 1:2625 MARTIN WAY E STE A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4900
Practice Address - Country:US
Practice Address - Phone:360-352-5145
Practice Address - Fax:360-956-9004
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor